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Comparative Study
. 2025 Nov 1;43(11):1832-1840.
doi: 10.1097/HJH.0000000000004117. Epub 2025 Aug 11.

Long-term safety and efficacy of renal sympathetic denervation in comparison to a population-based cohort: a propensity-matching approach

Victor J M Zeijen  1 , Martijn J Tilly  1   2 , Kari A Saville  1 , Bruno H C Stricker  2 , Isabella Kardys  1 , M Kamran Ikram  2   3 , Maryam Kavousi  2 , Joost Daemen  1
Affiliations
Comparative Study

Long-term safety and efficacy of renal sympathetic denervation in comparison to a population-based cohort: a propensity-matching approach

Victor J M Zeijen et al. J Hypertens. .

Abstract

Objective: To evaluate the long-term changes in risk of cardiovascular outcomes and blood pressure (BP) in hypertensive patients treated with renal sympathetic denervation (RDN) as compared to hypertensive controls from a population-based cohort.

Methods: This prospective cohort study included patients with office systolic blood pressure (SBP) at least 140 mmHg and/or diastolic BP at least 90 mmHg. Patients treated with RDN were matched to hypertensive controls from the population-based Rotterdam Study using one-to-many variable-ratio propensity score matching. The primary safety outcome was a composite endpoint of myocardial infarction, coronary revascularization, stroke, renal failure and mortality. The primary efficacy outcome was the 5-year change in office SBP.

Results: A total of 53 RDN patients were matched to 238 population-based controls. Median age [25th-75th percentile] was 60.5 [56.5-68.4] years (46% female). Baseline BP ±SD was 166.1/95.5 ± 20.6/10.9 mmHg. Patients were prescribed 2.8 [1.5-4.5] defined daily dosages of antihypertensive drugs. The incidence of the primary safety outcome was similar among the RDN group and the control group at 5 years [13 vs. 18%; hazard ratio 0.93; 95% confidence interval (CI) 0.36-2.38; P = 0.87]. The 5-year change in SBP was -12.0 [-18.0, -6.0] mmHg in the RDN group ( P < 0.001) and -14.9 [-22.5 to -7.3] mmHg in the control group ( P < 0.001), with no significant between-group difference [2.9 (-6.6 to 12.4) mmHg; P = 0.55].

Conclusion: Patients with uncontrolled hypertension undergoing RDN did not have a significantly lower risk for future adverse cardiovascular events as compared to hypertensive controls from a population-based study. No difference in office BP was observed at 5 years. While real-world observational data could provide valuable insights, randomized trials are needed to confirm the role of RDN in improving long-term outcomes.

Keywords: blood pressure; cohort studies; glomerular filtration rate; hypertension; kidney; sympathectomy.

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Conflict of interest statement

J.D. received institutional grant/research support from Abbott Vascular, Boston Scientific, ACIST Medical, Medtronic, Pie Medical, and ReCor medical, and consultancy and speaker fees from Abbott Vascular, Abiomed, ACIST medical, Boston Scientific, Cardialysis BV, CardiacBooster, Kaminari Medical, ReCor Medical, PulseCath, Pie Medical, Sanofi, Siemens Healthcare and Medtronic. All other authors declare no relevant interests to disclose.

Figures

FIGURE 1
FIGURE 1
Study flowchart. 1A total of 2122 patients (5 RDN group, 2117 control group) were not eligible for participation in the current study (details provided in Supplementary Table 3). 2A total of 817 patients (37 RDN group, 780 control group) who did not complete the 5-year follow-up visit were excluded from the efficacy outcome analyses in the propensity-matched cohort. RDN, renal sympathetic denervation.
FIGURE 2
FIGURE 2
Occurrence of the primary safety outcome (composite endpoint) in the matched sample. CI, confidence interval; RDN, renal sympathetic denervation. Cox proportional hazards models with cluster-robust standard errors were performed to adjust for data clustering within matched pairs. Matching weights were applied in all models to adjust for variable ratio matching. The P value was derived from the robust score test.
FIGURE 3
FIGURE 3
Changes in blood pressure and prescribed antihypertensive drugs between baseline and 5 years in the matched sample. RDN, renal sympathetic denervation.
See this image and copyright information in PMC

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