Blood pressure reduction after renal denervation was similar for patients with varying high-risk comorbidities and baseline cardiovascular risk, according to a study published June 8 in the Journal of the American College of Cardiology. However, the impact of baseline cardiovascular risk on clinical event reduction by renal denervation-induced blood pressure changes may need to be evaluated in further studies.

Using data from the Global SYMPLICITY Registry, Felix Mahfoud, MD, et al., sought to assess blood pressure reduction and event rates after renal denervation in 3,000 patients with various co-morbidities, testing the hypothesis that renal denervation is effective and durable in these high risk populations.

Results showed that reduction in 24-hour systolic blood pressure at three years was –8.9 ± 20.1 mm Hg for the overall cohort. For high risk subgroups, the authors found that blood pressure reduction was –10.4 ± 21.0 mm Hg for resistant hypertension, –8.7 ± 17.4 mm Hg in patients 65 years or older, –10.2 ± 17.9 mm Hg in patients with diabetes, –8.6 ± 18.7 mm Hg in isolated systolic hypertension, –10.1 ± 20.3 mm Hg in chronic kidney disease, and –10.0 ± 19.1 mm Hg in atrial fibrillation.

Furthermore, the researchers found that blood pressure reduction in patients with measurements at six, 12, 24 and 36 months showed similar reductions in office and 24-hour blood pressure for patients with varying baseline ASCVD risk scores. Adverse event rates at three years were found to be higher for patients with higher baseline cardiovascular risk.

“Future targeted studies are warranted to investigate efficacy of renal denervation in lowering blood pressure in patients with isolated systolic hypertension and other diseases marked by increased sympathetic activity,” the authors conclude.

In an accompanying editorial comment, Stephen C. Textor, MD, writes that “the outcomes reported here suggest that age, diabetes, isolated systolic hypertension, chronic kidney disease or other demographic data do not reliably demarcate the populations likely to respond to renal denervation.” He adds, “Identifying the truly optimal candidates for renal denervation remains the unresolved ‘holy grail’ for this technology.”

Clinical Topics: Arrhythmias and Clinical EP, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension

Keywords: Blood Pressure, Atrial Fibrillation, Risk Factors, Hypertension, Denervation, Kidney, Renal Insufficiency, Chronic, Diabetes Mellitus, Registries

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