Hyperresponders vs. nonresponder patients after renal denervation: do they differ?
BACKGROUND
Blood pressure (BP) response after renal denervation (RDN) is highly variable. Besides baseline BP, no reliable predictors of response have been consistently identified. The differences between patients showing a major BP decrease after RDN vs. nonresponders have not been studied so far.


OBJECTIVE
We identified extreme BP responders (first quintile) and nonresponders (fifth quintile) to RDN defined according to office or 24-h ambulatory BP in the European Network COordinating research on Renal Denervation database (n = 109) and compared the baseline characteristics and BP changes 6 months after RDN in both subsets.


RESULTS
In extreme responders defined according to ambulatory BP, baseline BP and BP changes 6 months after RDN were similar for office and out-of-the office BP. In contrast, extreme responders defined according to office BP were characterized by a huge white-coat effect at baseline, with dramatic shrinkage at 6 months. Compared with nonresponders, extreme responders defined according to office BP were more frequently women, had higher baseline office--but not ambulatory--BP, and higher estimated glomerular filtration rate (eGFR). In contrast, when considering ambulatory BP decrease to define extreme responders and nonresponders, the single relevant difference between both subsets was baseline ambulatory BP.


CONCLUSIONS
This study suggests a major overestimation of BP response after RDN in extreme responders defined according to office, but not ambulatory BP. The association of lower eGFR with poor response to RDN is consistent with our previous analysis. The increased proportion of women in extreme responders may reflect sex differences in drug adherence.
aPole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain bDivision of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium cAssistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris, France dStudies Coordinating Center, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, Leuven, Belgium eDepartment of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden fThird Department of Internal Medicine, General Faculty Hospital, Prague, Czech Republic gDepartment of Cardiology, Ullevaal University Hospital, University of Oslo, Oslo, Norway hDepartment of Cardiology, Geneva University Hospitals, Geneva iDepartment of Nephrology, Lausanne University Hospital, Lausanne, Switzerland jBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom kDepartment of Cardiology, Isala Klinieken, Zwolle, the Netherlands lKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden mDepartment of Epidemiology, Maastricht University, Maastricht, the Netherlands.
Alexandre
A
Persu
Michel
M
Azizi
Yu
Y
Jin
Sebastian
S
Volz
Jan
J
Rosa
Fadl Elmula M
FE
Fadl Elmula
Antoinette
A
Pechere-Bertschi
Michel
M
Burnier
Patrick B
PB
Mark
Arif
A
Elvan
Jean
J
Renkin
Marc
M
Sapoval
Thomas
T
Kahan
Sverre
S
Kjeldsen
Jan A
JA
Staessen
D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D017115:Catheter Ablation; D015331:Cohort Studies; D003714:Denervation; D005060:Europe; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D016896:Treatment Outcome