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Randomized Controlled Trial
. 2017 Jan 7;38(2):93-100.
doi: 10.1093/eurheartj/ehw325.

Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry

Felix Mahfoud  1 , George Bakris  2 , Deepak L Bhatt  3 , Murray Esler  4 , Sebastian Ewen  1 , Martin Fahy  5 , David Kandzari  6 , Kazuomi Kario  7 , Giuseppe Mancia  8 , Michael Weber  9 , Michael Böhm  1
Affiliations
Randomized Controlled Trial

Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry

Felix Mahfoud et al. Eur Heart J. .

Abstract

Aims: Catheter-based renal artery denervation (RDN) has been shown to lower blood pressure (BP) in certain patients with uncontrolled hypertension. Isolated systolic hypertension (ISH) (systolic BP [SBP] ≥140 mmHg and diastolic BP <90 mmHg), characterized by increased vascular stiffness, is the predominant hypertensive phenotype in elderly patients. This study compared baseline characteristics and SBP change at 6 months between patients with ISH and combined systolic–diastolic hypertension (CH).

Methods and results: This study pooled data from 1103 patients from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. A total of 429 patients had ISH, and 674 had CH. Patients with ISH were significantly older than those with CH (66 vs. 55 years), had more type 2 diabetes mellitus (52.9 vs. 34.6%), and a lower estimated glomerular filtration rate (71.8 vs. 78.6 mL/min/1.73 m2); all P < 0.001. At 6 months, the SBP drop for CH patients was −18.7 ± 23.7 mmHg compared with a reduction of −10.9 ± 21.7 mmHg for ISH patients −7.8 mmHg, 95% confidence interval, CI, −10.5, −5.1, P < 0.001). The change in 24-h SBP at 6 months was −8.8 ± 16.2 mmHg in patients with CH vs. −5.8 ± 15.4 mmHg in ISH (−3.0 mmHg, 95% CI −5.4, −0.6, P = 0.015). Presence of ISH at baseline but not age was associated with less pronounced BP changes following the procedure. The strongest predictor of office SBP reduction at 6 months was CH, followed by aldosterone antagonist use and non-use of vasodilators.

Conclusion: The reduction in BP among patients with ISH following RDN was less pronounced than the reduction in patients with CH.

Clinical.trials.gov identifiers: NCT01534299 and NCT01418261.

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Figures

Figure 1
Figure 1
Office systolic blood pressure change at 6 months. BL, baseline; CH, combined (systolic–diastolic) hypertension; GSR, Global SYMPLICITY Registry; HTN-3, SYMPLICITY HTN-3 trial; ISH, isolated systolic hypertension; RDN, catheter-based renal denervation.
Figure 2
Figure 2
24-h ambulatory systolic blood pressure change at 6 months. BL, baseline; CH, combined (systolic–diastolic) hypertension; GSR, Global SYMPLICITY Registry; HTN-3, SYMPLICITY HTN-3 trial; ISH, isolated systolic hypertension; RDN, catheter-based renal denervation.
Figure 3
Figure 3
Pooled dataset: change in systolic blood pressure for age ≥65 vs. <65 years at 6 months for patients with combined systolic–diastolic hypertension or isolated systolic hypertension. BL, baseline.
See this image and copyright information in PMC

Comment in

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