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Randomized Controlled Trial
. 2022 Feb 1;40(2):221-228.
doi: 10.1097/HJH.0000000000002994.

Plasma renin and aldosterone concentrations related to endovascular ultrasound renal denervation in the RADIANCE-HTN SOLO trial

Naomi D L Fisher  1 , Ajay J Kirtane  2 , Joost Daemen  3 , Florian Rader  4 , Melvin D Lobo  5 , Manish Saxena  5 , Josephine Abraham  6 , Roland E Schmieder  7 , Andrew S P Sharp  8 , Philippe Gosse  9 , Lisa Claude  10 , Yang Song  11 , Michel Azizi  12   13   14 ; RADIANCE-HTN Investigators
Affiliations
Randomized Controlled Trial

Plasma renin and aldosterone concentrations related to endovascular ultrasound renal denervation in the RADIANCE-HTN SOLO trial

Naomi D L Fisher et al. J Hypertens. .

Abstract

Objective: The RADIANCE-HTN SOLO trial demonstrated a greater reduction in daytime ambulatory SBP at 2 months by endovascular ultrasound renal denervation than sham procedure. We hypothesized that plasma renin and aldosterone concentrations would be associated with the SBP response to renal denervation.

Methods: Hypertensive patients were randomized to renal denervation (n = 74) or sham (n = 72) after a 4-week washout of antihypertensive medications. In a 53-patient subset, 2-month and 6-month plasma renin and aldosterone concentration were measured. Dietary sodium was not controlled.

Results: Mean age of the 29 treatment and 24 sham patients was 54 years; 62% were men; 17% black. Daytime ambulatory SBP fell in the denervation but not the sham group at 2 months (-7.8 ± 10.7 vs. -0.1 ± 10.1 mmHg; P = 0.048). Baseline plasma renin and aldosterone concentrations were in the low-normal range, did not change significantly at 2 months in either group and did not predict response to renal denervation. At 6 months, after the addition of antihypertensive medications, there was a significant rise in renin in the sham but not the denervation group.

Conclusion: Although renal denervation but not sham resulted in a decrease in daytime ambulatory SBP at 2 months, renin and aldosterone concentrations did neither predict the BP response to renal denervation; nor did they fall after denervation. A rise in renin at 6 months in the sham group likely represents confounding from antihypertensive medications. Whether the BP-lowering effect of renal denervation depends on reducing local intrarenal renin release requires further study.

Trial registration: ClinicalTrials.gov NCT02649426.

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References

    1. Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Davies J, et al. RADIANCE-HTN Investigators. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet 2018; 391:2335–2345.
    1. Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Lobo MD, et al. Six-month results of treatment-blinded medication titration for hypertension control after randomization to endovascular ultrasound renal denervation or a sham procedure in the RADIANCE-HTN SOLO Trial. Circulation 2019; 139:2542–2553.
    1. Mauri L, Kario K, Basile J, Daemen J, Davies J, Kirtane AJ, et al. A multinational clinical approach to assessing the effectiveness of catheter-based ultrasound renal denervation: The RADIANCE-HTN and REQUIRE clinical study designs. Am Heart J 2018; 195:115–129.
    1. Gruson D, Maisin D, Lison P, Maiter D, Persu A. Two-site automated chemiluminescent assay for measurement of immunoreactive renin. Biomarkers 2011; 16:605–609.
    1. Morganti A. A comparative study on inter and intralaboratory reproducibility of renin measurement with a conventional enzymatic method and a new chemiluminescent assay of immunoreactive renin. J Hypertens 2010; 28:1307–1312.

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