Renal denervation in patients with resistant hypertension reduced systolic blood pressure by 18.4 mmHg at 12 months and increased the proportion achieving SBP <130 mmHg from 12.8% to 26.8%.
Observational (n=142)
Yes
Does renal denervation improve blood pressure control and Time in Therapeutic Range in adults with resistant hypertension?
Renal denervation in patients with resistant hypertension provides sustained reductions in blood pressure and improves the time in therapeutic range over 12 months, even with concurrent reductions in antihypertensive medications.
Abstract Background Despite the wide availability of antihypertensive agents, controlling blood pressure (BP) in patients with resistant hypertension remains challenging, leading to increased cardiovascular morbidity and mortality 1. Renal denervation (RDN), targeting sympathetic overactivity, has shown promise as a device-based therapy 2. However, the relevance of early post-procedural BP reductions remains incompletely characterized. Purpose This nationwide registry evaluated the relationship between early post-RDN BP changes and 12-month outcomes, focusing on treatment response and Time in Therapeutic Range (TTR) for systolic BP (SBP) 130 mmHg and diastolic BP (DBP) 80 mmHg. Methods Adults (≥18 years) with resistant hypertension confirmed by 24-hour ambulatory monitoring and office/home BP measurement underwent RDN via standardized protocols Office SBP/DBP were measured at baseline, discharge (~1 week), and at 1, 3, 6, and 12 months. Antihypertensive regimens were recorded to calculate a "medication burden," defined as the sum of prescribed dose ratios relative to standard reference doses. Adjusted BP was obtained by subtracting 10 mmHg (SBP) and 5 mmHg (DBP) for each 0.5 reduction in medication burden from baseline. TTR was the proportion of patients meeting SBP 130 or DBP 80 at each visit; adjusted TTR accounted for medication changes. Early BP changes were evaluated for predictive value of 12-month outcomes. Results Of 142 patients treated with RDN, mean baseline SBP/DBP was 155.2±24.0/84.1±14.2 mmHg. SBP declined by –12.7±29.8 mmHg at discharge and –18.4±31.6 mmHg (–9.9%±19.7%) at 12 months. After adjusting for medication burden, the 12-month SBP reduction reached –29.5±36.7 mmHg (–18.5%±24.0%). DBP followed a similar pattern, dropping by –6.9±17.4 mmHg at discharge and –6.3±20.5 mmHg (–4.7%±25.3%) at 12 months, and by –13.0±18.4 mmHg (–15.1%±23.1%) when adjusted for medication burden. Overall antihypertensive therapy declined from 2.25±1.19 to 1.74±1.26 at 12 months (Δ=–0.76±1.26). Notably, a SBP reduction of ≥6.0 mmHg at discharge predicted a ≥10 mmHg adjusted SBP reduction at 12 months (AUC=0.68, sensitivity=63%, specificity=70%). The proportion achieving SBP 130 mmHg (TTR) rose from 12.8% at baseline to 26.8% at 12 months, and to 39.7% when adjusted. DBP 80 mmHg TTR increased from 39.0% to 55.1%, and to 59.7% after adjustment. Conclusion In this nationwide registry of resistant hypertension, RDN yielded significant SBP and DBP reductions from discharge through 12 months. TTR for SBP 130 and DBP 80 improved steadily, even after medication adjustments. These findings underscore the therapeutic potential of RDN for durable BP control.Table 1. Figure 1.
Wu et al. (Sat,) conducted a observational in resistant hypertension (n=142). Renal denervation was evaluated on Treatment response and Time in Therapeutic Range (TTR) for systolic BP <130 mmHg and diastolic BP <80 mmHg at 12 months. Renal denervation in patients with resistant hypertension reduced systolic blood pressure by 18.4 mmHg at 12 months and increased the proportion achieving SBP <130 mmHg from 12.8% to 26.8%.