Renal denervation (RDN) with the multi-electrode Symplicity Spyral system in patients with hypertension and not taking antihypertensive medications was associated with decreased plasma renin activity (PRA) and aldosterone levels at three months compared with a blinded sham-controlled group, according to a study published May 3 in the Journal of the American College of Cardiology, and being presented at ACC.21.

Felix Mahfoud, MD, et al., sought to evaluate PRA and aldosterone before and after RDN, and assess whether these baseline neuroendocrine markers predict response to RDN. In the study, patients in the SPYRAL HTN-OFF MED Pivotal trial with no antihypertensive medications were separated into two groups, those with baseline PRA ≥0.65 (n=110) vs. <0.65 ng/mL/hour (n=116). Aldosterone and PRA levels were compared at baseline and three months post-procedure for RDN and sham control groups.

Results showed that baseline PRA was similar between the RDN and sham control groups (1.0±1.1 vs. 1.1±1.1 ng/mL/hour, p=0.37). Researchers also found that change in PRA from baseline to three months was significantly greater for RDN (-0.2±1.0 ng/mL/hour, p=0.019) compared with sham control groups (0.1±0.9 ng/mL/hour, p=0.14). Similarly, change in aldosterone from baseline to three months was significantly greater for RDN (-1.2±6.4 ng/dL, p=0.04) compared with sham control groups (0.4±5.4 ng/dL, p=0.40).

"[Patients] with baseline PRA ≥0.65 ng/mL/hour had greater 24-hour and office [systolic blood pressure] reduction at [three] months compared with patients with baseline PRA<0.65 ng/mL/hour," write the authors of the study. "These differences emerged by [two] weeks following RDN indicating that the procedure impacts renal physiology as early as two weeks following treatment."

"To our way of thinking the results are sobering," write Franz H. Messerli, MD, FACC, et al., in an accompanying editorial comment. "Clearly, the paper of Mahfoud et al., is one more solid pebble in the mosaic assessing the antihypertensive mechanism of RDN and also attesting to its similarity to beta-blockade."

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Novel Agents, Hypertension

Keywords: ACC Annual Scientific Session, ACC21, Antihypertensive Agents, Aldosterone, Renin, Blood Pressure, Control Groups, Hypertension, Kidney, Hypotension, Denervation, Electrodes, Plasma

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