Blood pressure changes after renal denervation at 10 European expert centers

Area of Science:

• Cardiology
• Nephrology
• Hypertension Research

Background:

• Essential hypertension remains a significant global health challenge, often requiring multi-drug regimens.
• Renal denervation (RDN) is an interventional therapy targeting the renal sympathetic nerves to lower blood pressure.
• The long-term efficacy and patient selection criteria for RDN require further investigation.

Purpose of the Study:

• To conduct a subject-level meta-analysis evaluating blood pressure changes after renal denervation.
• To assess the effectiveness of RDN at 3 and 6 months post-procedure using office and ambulatory BP monitoring.
• To identify predictors of treatment response and non-response to RDN.

Main Methods:

• A meta-analysis of data from 109 patients with essential hypertension across 10 European centers.
• Collected and analyzed office and 24-hour ambulatory blood pressure measurements at baseline, 3 months, and 6 months.
• Statistical analysis included assessment of BP changes, normalization rates, improvement percentages, and logistic regression for predictors.

Main Results:

• Systolic/diastolic office BP decreased by 17.6/7.1 mmHg, and 24-h ambulatory BP by 5.9/3.5 mmHg at 6 months (P<0.03).
• At 6 months, office BP normalization/improvement was achieved in 82.5% of patients; 24-h BP normalization/improvement in 45.9%.
• Higher baseline BP predicted greater BP reduction; elevated serum creatinine was associated with lower improvement rates and higher likelihood of no BP decrease.

Conclusions:

• Renal denervation leads to significant blood pressure reduction, but responses may include regression-to-the-mean.
• Further randomized trials using ambulatory BP monitoring are needed to consolidate RDN's efficacy.
• RDN should be considered a last resort for resistant hypertension and used cautiously in patients with renal impairment.