THREE-YEAR NIGHTTIME BLOOD PRESSURE REDUCTIONS AFTER RADIOFREQUENCY RENAL DENERVATION IN PATIENTS WITH UNCONTROLLED HYPERTENSION AND CHRONIC KIDNEY DISEASE

Abstract

Objective: Nocturnal hypertension (HTN), highly prevalent in chronic kidney disease (CKD), is strongly associated with cardiovascular risk, and is difficult to control with pharmacotherapy. An additional therapy such as radiofrequency renal denervation (RF RDN) may effectively lower nighttime BP in hypertensive patients with CKD, long-term. Design and method: Patients with uncontrolled HTN enrolled into the Global SYMPLICITY Registry (GSR) DEFINE were evaluated. All patients underwent RF RDN and were grouped by their estimated glomerular filtration rate (eGFR): <60mL/min/1.73m2 (CKD) or eGFR more than or equal to 60mL/min/1.73m2 (non-CKD). Nighttime systolic BP (NSBP) changes at 3yrs after RF RDN were compared between groups. Results: As of March 2023, a total of 3331 patients with uncontrolled BP were enrolled of which 805 (24.2%) had CKD. CKD group were 64±12yrs old, 47.3% female, 54.9% had diabetes, and 56.9% had cardiac disease. Of those, 12.3% had eGFR <30mL/min/1.73m2 (Figure 1A). The baseline NSBP was higher in the CKD vs non-CKD groups (149.0±22.9mmHg vs 144.9 ± 21.0mmHg; p=0.0002), whilst prescribed 5.2±1.7 vs 4.8 ± 1.7 antihypertensive drugs, respectively (p<0.0001). 3yrs after RF RDN, significant NSBP change was observed in the CKD group (-7.8mmHg), similar to the non-CKD group (-8.4mmHg; adjusted p=0.64; Figure 1B). The eGFR changed similarly in both groups (CKD -4.7±17.4mL/min/1.73m2 vs non-CKD -7.0±17.0mL/min/1.73m2; p=0.34). There was also no significant difference between groups for changes in daytime SBP, sodium, potassium, or creatinine. Conclusions: In this large registry cohort of patients with CKD and uncontrolled BP, nocturnal HTN was prevalent, and RF RDN significantly reduced NSBP after 3 years. RDN, in addition to pharmacotherapy, may help to reduce the risk of long-term cardiovascular events in these high risk patients.