Arterial hypertension is a modifiable risk factor for cardiovascular events. In many cases, however, patients struggle to maintain control over time.
Renal denervation (RDN) has emerged as a therapeutic strategy for arterial hypertension, showing benefits in lowering blood pressure both in 24-hour ambulatory monitoring (ABPM) and in office measurements (OFFICE). However, results have not been conclusive in some analyses.
Researchers conducted an analysis at two years of the SPIRAL HTN-ON MED study, which included 337 patients with uncontrolled hypertension who were receiving between 1 and 3 antihypertensive drugs. The assessment was carried out through OFFICE and ABPM blood pressure measurements. Among the subjects, 206 underwent RDN while the acted as the control group (CG).
Uncontrolled hypertension was defined as OFFICE systolic blood pressure >150 mmHg and <180 mmHg, with diastolic blood pressure ≥90 mmHg, and ABPM systolic blood pressure ≥140 mmHg and <170 mmHg.
Baseline characteristics were similar between groups: the mean age was 55 years and 80% of subjects were men. Hypertension duration was greater than 5 years in most patients; approximately 6% had coronary, 13% had diabetes, preserved renal function, and a stroke/TIA rate of 1%.
Initial blood pressure was 163/101 mmHg in OFFICE and 149/106 mmHg in ABPM. There were no differences in the number of drugs received between groups (1.8 in RDN vs. 1.7 in CG).
At 24 months, there was a significant reduction in systolic blood pressure in ABPM (−12.1±15.3 mmHg vs. −7.0±13.1 mmHg; difference between treatments: −5.7 mmHg; p=0.039). This reduction was sustained during both day and night and was accompanied by a decrease in the medication used.
Conclusion
Renal denervation achieves a significant reduction in systolic blood pressure, both ambulatory and in office, at 24 months compared with the control group, despite the greater use of antihypertensive medication in the latter.
Original Title: Long-Term Safety and Efficacy of Renal Denervation: 24-Month Results From the SPYRAL HTN-ON MED Trial.
Reference: David E. Kandzari, et al. Circ Cardiovasc Interv. 2025;18:e015194. DOI: 10.1161/CIRCINTERVENTIONS.125.015194.
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