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Renal denervation (RDN) with the Symplicity™ catheter represents a novel approach to the treatment of resistant hypertension (rHTN) and significantly lowers blood pressure (BP) in these patients. However, a proportion of patients do not initially respond to RDN (systolic BP drop of <10 mm Hg), whilst others demonstrate an exaggerated BP response (hyper-responders, highest quintile of BP drop). This analysis sought to identify baseline predictors of non- or hyper-response to RDN in rHTN patients.
BP data from the previously reported Symplicity HTN-1 and Symplicity HTN-2 trials were pooled. Univariate and multivariate regression analysis of 22 clinically relevant baseline characteristics was performed to identify predictors of both non-response and hyper-response at 6 months and 12 months post-RDN.
There were 242 patients (mean age 57 years, 41% female; baseline BP =178.2±17.7/98.1±14.9 mm Hg) included in the analysis. At 6 months post-RDN, change from baseline was −24.3 ± 23.4 mm Hg for systolic BP (SBP) and −10.1 ± 12.9 mm Hg for diastolic BP; 27.6% of patients met the definition of non-responder. At 12 months, SBP change was −26.4±23.8 and DBP change was −12.1±13.2 mm Hg; 25% of patients were non-responders. Significant multivariate predictors of 6 month non-response were a higher baseline heart rate (odds ratio [OR] 1.045, p=0.049) and fewer baseline medications (OR 0.697, p=0.035). At 12 months, no baseline variables predicted non-response. Among hyper-responders, the mean SBP change from baseline was −56.3±13.7 mm Hg at 6 months and −60.6 ± 15.0 mm Hg at 12 months. A high baseline SBP (OR 1.062, p<0.001) and non-diabetic status (OR 3.217, p=0.016) were significantly associated with a hyper-response at 6 months. At 12 months high baseline SBP (OR 1.058, p<0.001), alpha blocker use (OR 0.321, p=0.039), and calcium channel blocker non-use (OR 3.067, p=0.012) predicted hyper-response.
Higher baseline heart rate and less medication use predicted 6 month but not 12 month non-response. High baseline SBP consistently predicted hyper-response. Further analysis of larger RDN-treated rHTN populations for predictors of BP response warranted.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Renal Denervation: Coming of Age
Abstract Category: 25. Prevention: Hypertension
Presentation Number: 1148-26
- 2013 American College of Cardiology Foundation