Blood pressure changes after renal denervation at 10 European expert centers

Abstract

We did a subject-level meta-analysis of the changes (Δ) in blood pressure (BP) observed 3 and 6 months after renal denervation (RDN) at 10 European centers. Recruited patients (n=109; 46.8% women; mean age 58.2 years) had essential hypertension confirmed by ambulatory BP. From baseline to 6 months, treatment score declined slightly from 4.7 to 4.4 drugs per day. Systolic/diastolic BP fell by 17.6/7.1 mm Hg for office BP, and by 5.9/3.5, 6.2/3.4, and 4.4/2.5 mm Hg for 24-h, daytime and nighttime BP (P0.03 for all). In 47 patients with 3- and 6-month ambulatory measurements, systolic BP did not change between these two time points (P0.08). Normalization was a systolic BP of <140 mm Hg on office measurement or <130 mm Hg on 24-h monitoring and improvement was a fall of 10 mm Hg, irrespective of measurement technique. For office BP, at 6 months, normalization, improvement or no decrease occurred in 22.9, 59.6 and 22.9% of patients, respectively; for 24-h BP, these proportions were 14.7, 31.2 and 34.9%, respectively. Higher baseline BP predicted greater BP fall at follow-up; higher baseline serum creatinine was associated with lower probability of improvement of 24-h BP (odds ratio for 20-μmol l(-1) increase, 0.60; P=0.05) and higher probability of experiencing no BP decrease (OR, 1.66; P=0.01). In conclusion, BP responses to RDN include regression-to-the-mean and remain to be consolidated in randomized trials based on ambulatory BP monitoring. For now, RDN should remain the last resort in patients in whom all other ways to control BP failed, and it must be cautiously used in patients with renal impairment.

Figure 1

The office and 24-h ambulatory BP values at baseline and at 3 and 6 months after RDN in 47 patients. SBP and DBP indicate systolic and diastolic BP, respectively. P-values denote the significance compared with baseline in unadjusted analyses.

Figure 2

Individual responses of systolic (a, c) and diastolic (b, d) BP on office (a, b) and 24-h ambulatory (c, d) measurement in 109 patients undergoing RDN.

Figure 3

Proportion of SYMPLICITY-HTN2 patients in the control (n=51) and RDN (n=49) group and proportion of patients in the current study that at 6 months had no decrease in the office systolic BP, a 10-mm Hg or greater decrease, or had a systolic BP of <140 mm Hg. For the current study, proportions are given for all patients (n=109) as well as for those who at baseline had an office systolic BP of 160 mm Hg or more (n=74). P-values are for the comparison between the SYMPLICITY HTN-2 RDN group and the current patients.