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Obesity may reduce BP response to renal denervation
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Lower BMI is associated with a more pronounced systolic BP reduction 6 months after renal denervation, researchers reported in Catheterization and Cardiovascular Interventions.
Patients with high systolic BP at baseline also exhibited a greater BP reduction after treatment.
In a single-center, uncontrolled, retrospective study, researchers evaluated 101 adults (61 men; median age, 63 years) with resistant hypertension who underwent renal denervation with the Symplicity catheter (Medtronic).
Patients underwent physical examinations at baseline and at 6 months after treatment. BP and serum creatinine were measured and estimated glomerular filtration rates were calculated at both time points. Seventy-one patients also underwent 24-hour ambulatory BP measurements.
The primary endpoint was change to systolic BP at 6 months. Other evaluated endpoints included renal function, renal artery stenosis and incidence of procedure-related complications.
The mean BP was 166.6/90.2 mm Hg at baseline. Both systolic and diastolic BP decreased at 6 months, to 151.9/84.9 mm Hg (P < .0001 for systolic and P < .001 for diastolic BP). Nonresponse, or a reduction in systolic BP of less than 10 mm Hg, occurred in 42.6% of patients. Results from the paired analysis of 24-hour ambulatory BP also indicated a reduction from 157.7/87 mm Hg at baseline to 150.9/82.9 mm Hg at 6 months (P < .0002 for systolic and P < .001 for diastolic BP).
No patients exhibited procedure-related adverse events during renal denervation. During follow-up, two patients underwent coronary intervention, but neither event was considered related to the procedure or device.
On univariate analysis, BMI at baseline was predictive of BP response (standardized beta = 0.24; r = 1.1; P = .014), with a lower BP response among obese patients (–8.9 mm Hg) compared with nonobese patients (–20.1 mm Hg; P = .013). Baseline systolic BP was also significantly predictive of BP response at 6 months (standardized beta = –0.47; r = –0.48; P < .0001), with a higher baseline BP associated with a greater response. Both BMI (standardized beta = 0.21; r = 0.95; P = .019) and baseline systolic BP (standardized beta = –0.46; r = –0.47; P < .0001) remained associated with BP response at 6 months on multivariate analysis.
The researchers noted that in the subgroup of patients with 24-hour ambulatory BP monitoring data, BMI remained predictive of BP response (standardized beta = 0.26; r = 0.78; P = .03), but baseline ambulatory BP did not.
“BP reduction after [renal denervation] appears to be less pronounced in obese than in nonobese hypertensive patients,” the researchers concluded. “As obesity-related hypertension is frequently resistant to pharmacological antihypertensive therapy, it might also be a frequent cause of nonresponse to [renal denervation] therapy. These findings may have implications regarding patient selection for renal denervation.” – by Adam Taliercio
Disclosure: One researcher reports ownership interest or financial relationships with numerous drug and device companies. Please see the full study for a list of these financial disclosures.
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