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Renal Denervation in High-Risk Subgroups
Quick Takes
- There were clinically and statistically significant reductions in office and 24-hour BP with renal denervation (RDN) that were maintained out to ≥3 years following the procedure.
- BP reduction after RDN was similar for patients with varying high-risk comorbidities and across the range of ASCVD risk scores.
- The potential to reduce clinical events by RDN treatment to lower BP independent of BP drug therapy remains high.
Study Questions:
What is the impact of blood pressure (BP) reduction and event rates after renal denervation (RDN) in high-risk populations?
Methods:
The investigators evaluated BP reduction and adverse events over 3 years for several high-risk subgroups in the GSR (Global proSpective registrY for syMPathetic renaL denervatIon in seleCted IndicatIons Through 3 Years Registry), an international registry of RDN in patients with uncontrolled hypertension (n = 2,652). Comparisons were made for patients age ≥65 years versus age <65 years, with versus without isolated systolic hypertension, with versus without atrial fibrillation, and with versus without diabetes mellitus. Baseline cardiovascular risk was estimated using the American Heart Association (AHA)/American College of Cardiology (ACC) atherosclerosis cardiovascular disease (ASCVD) risk score.
Results:
Reduction in 24-hour systolic BP at 3 years was -8.9 ± 20.1 mm Hg for the overall cohort, and for high-risk subgroups, BP reduction was -10.4 ± 21.0 mm Hg for resistant hypertension, -8.7 ± 17.4 mm Hg in patients age ≥65 years, -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 (p < 0.0001 compared with baseline for all). BP reduction in patients with measurements at 6, 12, 24, and 36 months showed similar reductions in office and 24-hour BP for patients with varying baseline ASCVD risk scores, which was sustained to 3 years. Adverse event rates at 3 years were higher for patients with higher baseline CV risk.
Conclusions:
The authors concluded that BP reduction after RDN was similar for patients with varying high-risk comorbidities and across the range of ASCVD risk scores.
Perspective:
This post hoc analysis from a real-world registry of RDN demonstrated clinically and statistically significant reductions in office and 24-hour BP in the entire cohort that were maintained out to ≥3 years following the procedure. Furthermore, the baseline adjusted BP-lowering effects were similar across subgroups and BP reductions were not dependent on baseline CV risk although, as expected, there were more adverse clinical events in higher CV risk subgroups. Additional prospective studies are indicated to assess the efficacy of RDN in preventing major adverse cardiovascular events in patients with isolated systolic and other specified forms of hypertension. At this time, as the risks associated with RDN appear to be reasonably low, the potential to reduce clinical events by RDN treatment to lower BP independent of BP drug therapy is high.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension
Keywords: Atherosclerosis, Atrial Fibrillation, Blood Pressure, Diabetes Mellitus, Hypertension, Kidney Diseases, Metabolic Syndrome, Primary Prevention, Renal Insufficiency, Chronic, Risk Factors, Sympathectomy, Vascular Diseases
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