Impact of baseline systolic blood pressure on blood pressure changes following renal denervation

Renal denervation (RDN) is a guideline-recommended treatment to reduce blood pressure (BP) in patients with uncontrolled hypertension. However, it is unclear if there are patient characteristics that are predictive of greater BP reduction. Baseline systolic blood pressure (SBP) has consistently been identified as an indicator of BP reduction after RDN.

Our study aimed to quantify the expected SBP change after RDN based on baseline SBP.

Patients undergoing radiofrequency RDN were pooled from multiple clinical studies, including SPYRAL First-In-Human (n=50), SYMPLICITY HTN-3 (n=364), SYMPLICITY HTN-Japan (n=22), SPYRAL HTN ON-MED (n=206), and the Global SYMPLICITY Registry DEFINE (n=2,735). Office and 24-hour ambulatory BP were measured at baseline and 6 months. Linear regression modelled patient-level 6-month SBP changes against baseline SBP.

The pooled cohort (N=3,377) had a mean age of 60±12 years, and 41% were female. Baseline office SBP (OSBP) and 24h ambulatory SBP (ASBP) were 171.8±20.5 mmHg and 155.9±17.3 mmHg, respectively. At 6 months, OSBP and 24h ASBP decreased by 16.3±24.0 and 7.5±16.7 mmHg, respectively. Patients were prescribed 4.4±1.5 antihypertensive drug classes at baseline and 4.3±1.5 at 6 months (p<0.0001). Higher baseline SBP correlated with greater SBP reductions (p<0.0001; r²=0.21 for OSBP; r²=0.13 for ASBP). Baseline OSBP of 150, 160, 170, and 180 mmHg were associated with 6-month reductions of 4.2, 9.8, 15.4, and 21.0 mmHg, respectively.

Baseline SBP was associated with 6-month SBP reductions after RDN in hypertensive patients. This relationship provides guidance for shared patient-clinician decision-making about what BP change to expect following radiofrequency RDN based on baseline SBP alone.