Ambulatory blood pressure changes and predictors of response in patients undergoing renal sympathetic denervation

Abstract

Background: Ambulatory blood pressure monitoring (ABPM) is important to identify hypertensive patients at risk. Catheter-based renal sympathetic denervation (RDN) reduces office blood pressure (BP) in patients with resistant hypertension according to office BP. Less is known about the effect of RDN on 24-hour BP and predictors of response in individuals with true or pseudo-resistant hypertension. Methods and results: A total of 346 uncontrolled hypertensive patients (office systolic BP ≥160 mmHg, ≥150 mmHg for type 2 diabetes), separated according to daytime ABPM into 303 with true resistant (office SBP 172.2±1.4 mmHg; 24-hour mean SBP 154±0.9 mmHg) and 43 with pseudo-resistant hypertension (office SBP 161.2±3.3 mmHg; 24-hour mean SBP 121.1±3 mmHg), from 10 centers were studied. Office systolic, diastolic and pulse pressure (SBP/DBP/PP) and ABPM (including daytime, nighttime, maximum, minimum BP) were measured at entry, and at 3, 6 and 12 months following RDN. At 3, 6 and 12 months follow-up office SBP was reduced by 21.5/23.7/27.3 mmHg, DBP by 8.9/9.5/11.7 mmHg, and PP by 13.4/14.2/14.9 mmHg (n=245/236/90; p for all <0.001), respectively. In patients with true treatment resistance there was a significant reduction with RDN in 24-hour mean SBP (-10.1/-10.2/-11.7 mmHg, p<0.001), DBP (-4.8/-4.9/-7.4 mmHg, p<0.001), maximum SBP (-11.7/-10.0/-6.1 mmHg, p<0.001) and minimum SBP (-6.0/-9.4/-13.1 mmHg, p<0.001) at 3, 6 and 12 months, respectively. There was no effect on ABPM in pseudo-resistant patients, while office BP was reduced to a similar extent. RDN was equally effective in reducing BP in different subgroups of patients (age, eGFR, dipping pattern, diabetic status, etc). Office SBP at baseline was the only independent predictor of BP response. Conclusions: RDN reduced office SBP, DBP, PP, ABPM average, daytime, nighttime, maximum and minimum BP in patients with true-treatment resistant hypertension. Our data from the largest cohort of patients treated by RDN and followed with ABPM up to 12 months demonstrate that in patients with true resistant hypertension the procedure improves relevant aspects of ABPM commonly linked to high cardiovascular risk, while it only affected office BP in pseudo-resistant hypertension.