Long-term prediction of blood pressure reduction after renal denervation for arterial hypertension

Abstract

Background: Renal denervation (RDN) has emerged as a potential therapy for lowering blood pressure (BP) in patients with arterial hypertension. However, approximately one-third of patients do not experience significant BP reductions, underscoring the need for reliable predictors of treatment response.

Objectives: This study evaluated the accuracy of a previously established bivariate prediction model for prediction of 3 months BP outcomes (based on baseline 24 h BP and ascending aortic distensibility) in predicting 24 h ambulatory BP outcomes up to 12 months post-RDN.

Design and methods: We conducted a predefined secondary analysis from a prospective single-centre trial (NCT02772939). Patients with resistant hypertension undergoing ultrasound-based RDN were enrolled. Invasive and noninvasive arterial stiffness markers were assessed before the procedure. BP response was evaluated at 6 and 12 months via 24 h ambulatory BP monitoring. Model performance was assessed using linear regression to predict 24 h ambulatory BP change and receiver operating curve analyses to assess the accuracy for a binary systolic ambulatory BP reduction of more than 5 mmHg.

Results: Eighty patients (mean age 63 ± 9 years, baseline 24 h SBP 150 ± 12 mmHg) were enrolled into this study. At 6 months, SBP decreased by 11 ± 15 mmHg, and by 7 ± 15 mmHg at 12 months ( P < 0.001 for both). The prediction model demonstrated high predictive accuracy at 6 months ( r2 = 0.45, AUC 0.82, P < 0.001), which decreased at 12 months ( r2 = 0.26, AUC 0.79, P < 0.001).

Conclusion: A noninvasive bivariate model effectively predicts BP response at 6 and 12 months post-RDN. These findings may enhance patient selection and shared decision-making, warranting further validation in larger studies.

Keywords: MRI; arterial compliance; hypertension; renal denervation; resistant hypertension.