Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry.
Catheter-based renal artery denervation (RDN) has been shown to lower blood pressure (BP) in certain patients with uncontrolled hypertension. Isolated systolic hypertension (ISH) (systolic BP [SBP] ≥140 mmHg and diastolic BP <90 mmHg), characterized by increased vascular stiffness, is the predominant hypertensive phenotype in elderly patients. This study compared baseline characteristics and SBP change at 6 months between patients with ISH and combined systolic–diastolic hypertension (CH).



This study pooled data from 1103 patients from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. A total of 429 patients had ISH, and 674 had CH. Patients with ISH were significantly older than those with CH (66 vs. 55 years), had more type 2 diabetes mellitus (52.9 vs. 34.6%), and a lower estimated glomerular filtration rate (71.8 vs. 78.6 mL/min/1.73 m2); all P < 0.001. At 6 months, the SBP drop for CH patients was −18.7 ± 23.7 mmHg compared with a reduction of −10.9 ± 21.7 mmHg for ISH patients −7.8 mmHg, 95% confidence interval, CI, −10.5, −5.1, P < 0.001). The change in 24-h SBP at 6 months was −8.8 ± 16.2 mmHg in patients with CH vs. −5.8 ± 15.4 mmHg in ISH (−3.0 mmHg, 95% CI −5.4, −0.6, P = 0.015). Presence of ISH at baseline but not age was associated with less pronounced BP changes following the procedure. The strongest predictor of office SBP reduction at 6 months was CH, followed by aldosterone antagonist use and non-use of vasodilators.



The reduction in BP among patients with ISH following RDN was less pronounced than the reduction in patients with CH.



NCT01534299 and NCT01418261.
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany.
Felix
F
Mahfoud
University of Chicago Medicine, Chicago, IL, USA.
George
G
Bakris
Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA.
Deepak L
DL
Bhatt
Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Murray
M
Esler
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany.
Sebastian
S
Ewen
Medtronic, Santa Rosa, CA, USA.
Martin
M
Fahy
Piedmont Heart Institute, Atlanta, GA, USA.
David
D
Kandzari
Jichi Medical University School of Medicine, Tochigi, Japan.
Kazuomi
K
Kario
University of Milano-Bicocca and Istituto Auxologico Italiano, Milan, Italy.
Giuseppe
G
Mancia
SUNY Downstate Medical Center, Brooklyn, NY, USA.
Michael
M
Weber
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Kirrberger Str., Geb. 40, Homburg/Saar 66421, Germany.
Michael
M
Böhm
D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012077:Renal Artery / Q000294:innervation / Q000601:surgery; D013562:Sympathectomy / Q000379:methods*; D013599:Systole / Q000502:physiology