title: Renal Denervation vs. Spironolactone in Resistant Hypertension: Effects on Circadian Patterns and Blood Pressure Variability.
abstract: BACKGROUND
  Sympathetic renal denervation (SRD) has been proposed as a therapeutic alternative for patients with resistant hypertension not controlled on pharmacological therapy. Two studies have suggested an effect of SRD in reducing short-term blood pressure variability (BPV). However, this has not been addressed in a randomized comparative trial. We aimed to compare the effects of spironolactone and SRD on circadian BP and BPV.
  
  
  METHODS
  This is a post-hoc analysis of a randomized trial in 24 true resistant hypertensive patients (15 men, 9 women; mean age 64 years) comparing 50mg of spironolactone (n = 13) vs. SRD (n = 11) on 24-hour BP. We report here the comparative effects on daytime (8 am-10 pm) and nighttime (0 am-6 am) BP, night-to-day ratios and BP and heart rate variabilities (SD and coefficient of variation of 24-hour, day and night, as well as weighted SD and average real variability (ARV)).
  
  
  RESULTS
  Spironolactone was more effective than SRD in reducing daytime systolic (P = 0.006), daytime diastolic (P = 0.006), and nighttime systolic (P = 0.050) BP. No differences were observed in the night-to-day ratios. In contrast, SRD-reduced diastolic BPV (24 hours, daytime, nighttime, weighted, and ARV; all P < 0.05) with respect to spironolactone, without significant differences in systolic BPV.
  
  
  CONCLUSIONS
  Spironolactone is more effective than SRD in reducing ambulatory BP. However, BPV is significantly more reduced with SRD. This effect could be important in terms of potential prevention beyond BP reduction and deserves further investigation.
authors.affiliation: Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain; adelasierra@mutuaterrassa.cat asierra@ub.edu.
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
authors.affiliation: Department of Internal Medicine, Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Pareja
authors.affiliation: Department of Internal Medicine, Hospital Moisés Broggi, Sant Joan Despí, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Armario
authors.affiliation: Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Barrera
authors.affiliation: Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Yun
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Vázquez
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Sans
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Oliveras
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D013148:Spironolactone / Q000627:therapeutic use*; D013562:Sympathectomy
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone
keywords: blood pressure; blood pressure variability; circadian blood pressure profile; hypertension; resistant hypertension; spironolactone; sympathetic renal denervation.