Renal denervation (RDN) is a guideline-recommended therapy to reduce blood pressure in patients with uncontrolled hypertension, although uncertainties remain regarding which factors best predict the treatment response. Higher baseline systolic blood pressure (SBP) has been associated with greater subsequent reductions—a phenomenon described by Wilder’s “law of initial value.” This study aimed to quantify the expected SBP changes at 6 months after radiofrequency renal denervation (RDN-RF) according to baseline values.
The primary endpoint was to determine the relationship between baseline SBP and changes in office and ambulatory SBP at 6 months after RDN-RF. The secondary endpoint included estimating the probability of blood pressure reduction within different ranges (0–20, 20–40 mmHg, etc.) and analyzing this relationship at 12 months.
Study Characteristics
The study pooled data from 3,377 patients with uncontrolled hypertension treated with RDN-RF from multiple clinical trials (SPYRAL FIH, SYMPLICITY HTN-3, SYMPLICITY HTN-Japan, SPYRAL HTN-ON MED, and SYMPLICITY DEFINE). All participants had a baseline SBP ≥140 mmHg and were receiving antihypertensive medication. Mean age was 60±12 years, 41% were women, with a BMI of 31.3±5.9 kg/m²; 38% had type 2 diabetes and 8.4% had a history of myocardial infarction. Baseline office SBP (OSBP) averaged 171.8±20.5 mmHg, and ambulatory SBP (ASBP) 155.9±17.3 mmHg. The mean number of antihypertensive medications was 4.4±1.5. At 6 months, OSBP and ASBP decreased by 16.3±24.0 and 7.5±16.7 mmHg, respectively (p<0.0001), with no clinically significant changes in medication burden (4.3±1.5; p<0.0001).
Linear regression analysis showed a significant correlation between baseline SBP and blood pressure reduction at 6 months: for every 10-mmHg increase in baseline SBP ≥140 mmHg, the average reduction was 5.6 mmHg for office BP (p<0.0001) and 4.3 mmHg for ambulatory BP (p<0.0001). Patients with baseline SBP levels of 150, 160, 170, and 180 mmHg had expected mean reductions of 4.2, 9.8, 15.4, and 21.0 mmHg, respectively. A patient with an SBP of 170 mmHg had a 76.5% probability of experiencing a BP decrease, whereas those with 190 mmHg had an 88.7% probability of reduction and a 62.2% probability of achieving a drop greater than 20 mmHg. Twelve-month analyses confirmed the persistence of this association.
How baseline SBP predicts blood pressure reduction after renal denervation
In conclusion, the higher the baseline SBP, the greater the expected blood pressure reduction at 6 months after RDN-RF. For every 10-mmHg increase in initial SBP, the mean decrease was 5.6 mmHg in office BP and 4.3 mmHg in ambulatory BP. The study confirms that baseline SBP is the strongest and simplest predictor of treatment response.
Original Title: Impact of baseline systolic blood pressure on blood pressure changes following renal denervation.
Reference: Roland E. Schmieder, MD; et al EuroIntervention. 2025;21:e1281–e1287. DOI: 10.4244/EIJ-D-24-01131.
Get the latest scientific articles on interventional cardiologySubscribe to our weekly newsletter
 es una terapia recomendada por las guías para reducir la presión arterial en pacientes con hipertensión no controlada, aunque persisten dudas sobre cuáles son los factores que mejor predicen la respuesta.){kind=link}