Abdominal aortic calcifications influence the systemic and renal hemodynamic response to renal denervation in the DENERHTN trial

Abstract

The DENERHTN trial confirmed the daytime ambulatory systolic blood pressure (dASPB) lowering efficacy of renal denervation (RDN) added to a standardized stepped-care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months. This post-hoc analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6 months. A total of 106 patients with resistant hypertension were randomly assigned to RDN + SSAHT, or the same SSAHT alone (control group). Total AAC volume was measured from the aortic hiatus to the iliac bifurcation, blind to randomization, with semiautomatic software, on the pre-randomization non-contrast abdominal CT-scans of 90 patients and expressed as tertiles. The baseline-adjusted difference in the change in dASBP from baseline to 6 months between the RDN and control groups was −10.1 mmHg ( P = 0.0462) in the lowest tertile of AAC volume and −2.5 mmHg ( P = 0.4987) in the two highest tertiles of AAC volume. Estimated glomerular filtration rate (eGFR) remained stable at 6 months in the patients with the lowest tertile of AAC volume who underwent RDN (+2.5 mL/min/1.73 m 2 ) but decreased in the control group (−8.0 mL/min/1.73 m 2 , P = 0.0148). In the two highest tertiles of AAC volume, eGFR decreased similarly in the RDN and the control groups ( P = 0.2640). RDN plus SSAHT resulted in a larger decrease in dASBP than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in dASBP was not associated with a decrease in eGFR.