Cluster analysis of 20 patients after renal denervation identified two main phenotypes, with one cluster (n=10) demonstrating a tendency toward increased mean daytime SBP (p=0.045).
Observational (n=20)
Does renal denervation improve blood pressure parameters in patients with resistant arterial hypertension?
Cluster analysis identified distinct phenotypes of hemodynamic response to renal denervation, which may help improve patient selection and outcome predictability in real-world practice.
Objective: Renal denervation (RDN) is an effective treatment option for resistant hypertension; however, the antihypertensive response shows substantial interindividual variability. Heterogeneous treatment effects observed in both randomized trials and real-world practice limit outcome predictability and complicate patient selection. Therefore, identification of clinical phenotypes associated with RDN effectiveness remains essential. Aim: To identify phenotypes of antihypertensive response in patients after renal denervation using cluster analysis.Design and method: The study included 20 patients with resistant arterial hypertension (according to ESH 2023 criteria) who underwent renal denervation using a spiral catheter. Clinical assessment was performed 12 months after the procedure. The following parameters were analyzed: office systolic and diastolic blood pressure (SBP/DBP), mean 24-hour, daytime and nighttime SBP/DBP, heart rate, and mean pulse pressure. Hierarchical cluster analysis with dendrogram construction using Ward's method and Euclidean distance was applied to determine the optimal number of clusters. Trajectories of changes in office and ambulatory blood pressure parameters were further analyzed using k-means clustering. Data are presented as median and interquartile range. Results: Ambulatory blood pressure monitoring identified three patterns of antihypertensive response: a reduction in mean SBP >5 mmHg (responders), absence of SBP reduction or an increase (non-responders), and a pronounced reduction in ambulatory SBP >20 mmHg (super-responders). Hierarchical clustering revealed two clearly distinguishable clusters, reflecting two major response trends. Cluster 1 (n = 10) was characterized by the absence of non-responders and a pronounced reduction in office SBP and DBP. Cluster 2 (n = 10) included all three response phenotypes and demonstrated a less pronounced antihypertensive effect, with a tendency toward increased mean daytime SBP (p = 0.045). Conclusions: Two main phenotypes of hemodynamic response to renal denervation were identified: one characterized by predominant reduction in office blood pressure without non-responders, and another showing a more uniform response across office and ambulatory measurements with heterogeneous treatment patterns. Cluster analysis may contribute to improved phenotyping and patient selection for renal denervation in real-world practice.
Orekhov et al. (Fri,) conducted a observational in resistant arterial hypertension (n=20). Renal denervation was evaluated on Phenotypes of antihypertensive response based on office and ambulatory blood pressure. Cluster analysis of 20 patients after renal denervation identified two main phenotypes, with one cluster (n=10) demonstrating a tendency toward increased mean daytime SBP (p=0.045).