Patients With Uncontrolled Hypertension, High Baseline Heart Rate Benefit Most From Renal Denervation: Presented at ESH

By Chris Berrie

BARCELONA, Spain -- June 12, 2018 -- Significant reductions in heart rate were seen 3 months after renal denervation for patients with uncontrolled hypertension, according to a study presented here at the 28th Scientific Meeting of the European Society of Hypertension (ESH).

Patients with higher baseline heart rate experienced greater reductions in ambulatory heart rate and BP following renal denervation, compared with patients with lower baseline heart rate, reported Michael Böhm, MD, Universität des Saarlandes, Homburg/Saar, Germany, and colleagues.

The findings were from a post-hoc analysis of the SPYRAL HTN-OFF MED trial, which randomised treatment-naïve patients with uncontrolled hypertension to receive renal denervation (n = 35) or sham procedure (n = 36). Findings from that study showed that 3 months after the procedure, there were significant improvements in systolic/diastolic blood pressure (BP).

For the current analysed, the researchers looked at data according to median baseline 24-hour heart rate.

For low baseline heart rate (<73.5 bpm), there were no significant differences from sham to renal denervation for average 24-hour systolic BP (-3.7 mm Hg vs -3.1 mm Hg), diastolic BP (-1.5 mm Hg vs -2.9 mm Hg), and heart rate (2.0 bpm vs -0.2 bpm).

Conversely, renal denervation provided significant benefits for patients with high baseline heart rate (≥73.5 bpm) for average 24-hour systolic BP (2.7 mm Hg vs. -8.4 mm Hg; P = .001), diastolic BP (0.7 mm Hg vs -7.1 mm Hg; P< .001), and heart rate (-2.3 bmp vs -5.2 bpm; P = .009).

At 3 months, average office, 24-hour, daytime and night-time heart rate were significantly reduced in the renal denervation group but not in the sham control group.

The authors said that a high average 24-hour heart rate provides a predictor of improved BP and heart rate responses post-renal denervation.

“It might allow physicians to select these patients [with uncontrolled hypertension and high baseline heart rate] for renal denervation,” said Dr. Böhm.

[Presentation title: Circadian Heart Rate Reduction After Catheter-Based Renal Denervation in Patients With Uncontrolled Hypertension in the Absence of Antihypertensive Medications - Data from SPYRAL HTN-OFF MED: a Randomized, Sham-Controlled, Proof-of-Concept Trial. Oral Session 3C]

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