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Renal denervation reduced ABPM-obtained BP in patients with true-resistant hypertension

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Results of a multicenter study have shown that renal denervation reduces BP obtained through ambulatory BP monitoring in patients with true-resistant hypertension, although this effect was not observed in a subset of patients with pseudo-resistant hypertension.

The study was conducted by Felix Mahfoud, MD, and colleagues and included 346 patients from 10 centers who had uncontrolled hypertension, despite being on at least three antihypertensive drugs, including one diuretic.

Patients were separated into two groups based on daytime ambulatory BP monitoring (ABPM): true-resistant hypertension (n=303; office systolic BP, 172.2 ± 22 mm Hg; 24-hour systolic BP 154 ± 16.2 mm Hg) and pseudo-resistant hypertension (n=43; office systolic BP, 161.2 ± 20.3 mm Hg; 24-hour systolic BP, 121.1 ± 19.6 mm Hg). All patients were treated with renal denervation.

At 3-month follow-up, office systolic BP was reduced by 21.5 mm Hg, office diastolic BP by 8.9 mm Hg and pulse pressure 13.4 mm Hg, reductions which were sustained out to 12 months (office systolic BP, –27.3; office diastolic BP, –11.7; pulse pressure, –14.9; P for all <.001).

 

Felix Mahfoud

Among patients with true-resistant hypertension, there was a significant reduction in 24-hour systolic BP (3 months, –10.1; 6 months, –10.2; 12 months, –11.7), diastolic BP (3 months, –4.8; 6 months, –4.9; 12 months, –7.4), maximum systolic BP (3 months, –11.7; 6 months, –10; 12 months, –6.1) and minimum systolic BP (3 months, –6; 6 months, –9.4; 12 months, –13.1; P for all <.001).

There was no significant effect of renal denervation on ABPM in patients with pseudo-resistant hypertension, although office BP was reduced to a similar extent. Baseline office systolic BP was the only independent predictor of BP response.

Mahfoud and colleagues wrote that recently there have been concerns that renal denervation might not be as effective at reducing ABPM as it is at reducing office BP.

“The results of the present multicenter study ... now confirm that renal denervation significantly reduces office and 24-hour average, daytime and nighttime BP in patients with true-resistant hypertension and increases the rate of patients controlled to target BP values, both according to office BP and ABPM,” they wrote

In an accompanying editorial, Gianfranco Parati, MD, Juan Eugenio Ochoa, MD, and Grzegorz Bilo, MD, PhD, wrote that the present study provides interesting novel insights into the efficacy of renal denervation and supports use of the approach in patients with true-resistant hypertension.

“At the same time, the results of this study emphasize the importance of combining out-of-office BP, and in particular 24-hour ABPM, to properly assess the effects of [renal denervation] on hypertension control in daily life,” they wrote.

For more information:

Mahfoud F. Circulation. 2013;doi:10.1161/circulationaha.112.000949.

Parati G. Circulation. 2013;doi:10.1161/circulationaha.113.003892.

Disclosure: Bilo, Ochoa and Parati report no relevant financial disclosures. Mahfoud received scientific support and speaker honorarium from Medtronic Ardian Inc.