Preprocedural features of patients under antihypertensive drugs may help identify responders to renal denervation: a hypothesis-generating study

Abstract

Background: Renal denervation (RDN) is effective to lower systolic blood pressure (SBP) in essential hypertension. However, patient selection under medications remains an important unmet clinical need. Methods: This multicenter study aimed at observing whether preprocedural features associated with increased renin-angiotensin-aldosterone activity influence RDN response. This study enrolled the patients who underwent RDN for uncontrolled hypertension. Medical records were reviewd and patients were divided into 2 groups depending by meeting any of the following conditions prior to RDN: (1) >10 mmHg of office SBP reduction after aldosterone inhibition, (2) aldosterone-renin ratio >30 or (3) slow flow on the renal angiogram. RDN responders were defined by a reduction in 24-hour mean ≥6 mmHg or by ≥1 class of antihypertensive drug withdraw. Results: A total of 46 patients were enrolled, of which 27 (59%) were in control group A and 19 (41%) in group B. The baseline age, gender, office and 24-hour SBP (mean 140.0 ± 12.8 mmHg vs. 144.0 ± 16.5 mmHg, p = 0.577) were comparable, while the number of prescribed drug classes was fewer in group A (4.0 ± 1.3 vs. 4.9 ± 0.9, p = 0.014). The proportion patients with prescribed aldosterone antagonist or high aldosterone-renin ratios were higher in group B. At 12 months post RDN, the results were significantly better in group B in terms of mean change in office SBP (12.4 ± 23.5 mmHg vs. 29.9 ± 25.5 mmHg, p = 0.046) and the proportion of RDN responders (51.9% vs. 89.5%, p < 0.001). Conclusion: RDN was more effective in patients with any of 3 clinical indices.

Patient‐Specific Factors Predicting Renal Denervation Response in Patients With Hypertension: A Systematic Review and Meta‐Analysis

“…The general characteristics and patient demographics of these studies are summarized in Table 1 . Due to the lack of valid data, the remaining 33 studies were used only for qualitative analysis, 12 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 and their basic characteristics are summarized in Table S2 .…”

“…Two studies with a low risk of bias, which were mainly for qualitative analysis due to the lack of valid data, reported that an increase in renin‐angiotensin‐aldosterone system (RAAS) activity is associated with the efficacy of RDN. 41 , 60 One study reported that patients with increased RAAS activity met at least 1 of the following criteria: (1) >10 mm Hg of office SBP reduction after aldosterone inhibition, (2) aldosterone‐renin ratio>30, or (3) slow flow on the renal angiogram 60 ; patients with these characteristics were inclined to benefit from RDN. The other study reported that the use of aldosterone antagonists was also associated with a decrease in BP after RDN.…”