Most hypertensive patients do not reach target blood pressure level ranges despite optimal medical treatment. Regardless anti-hypertensive medication, patients undergoing radiofrequency renal denervation have seen significant improved control of blood pressure, with relevant clinical impact.
One of the outcomes we look at in chronic diseases such as hypertension and diabetes is time in target range (TTR) looking at how much time patients spend within a target BP range. In the context of hypertension, TTR has been shown to be an independent predictor of cardiovascular event reduction.
This study looked at 3-year outcomes of the randomized sham controlled SPYRAL HTN-ON MED assessing TTR (target blood pressure at office/ambulatory ≤140mmHg) in patients receiving renal denervation vs. sham control.
80 patients were randomized, mean age 53.9, mostly men (87%) with average 24hr systolic blood pressure 152 ±7 mmHg, with 93% adherence to medication in the SHAM group.
Prior studies had shown that patients with renal denervation had seen significant reduction of target blood pressure within 24 hrs. (Δ -10.0 mmHg, P=0.04). This study showed higher TTR for both office and ambulatory blood pressures (<140mmHg) at study kickoff and later at 6, 12, 24 and 36 month followup (non-significantly).
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When looking at hypertension measurements, there was lower severe hypertension (≥180mmHg) in the renal denervation branch (3% vs 8.8%). When combining office ≤140 and ambulatory BPs ≤130 mmHg, TTR accuracy improved significantly.
Conclusions
Patients undergoing renal denervation presented significantly higher TTR. We should look at the clinical implications of higher TTR with renal denervation, which helps reduce cardiovascular events.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Original Title: Renal Denervation Increases Long-term Time in Target Blood Pressure Range Compared with Sham Control (SPYRAL-HTN on-meds).
Source: Presented by Kandzari, D. E. en EuroPCR 2022, París, Francia.
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