Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range

Mahfoud F, Mancia G, Schmieder R, Ruilope L, Narkiewicz K, Schlaich M, Williams B, Ribichini F, Weil J, Kao HL, Rodriguez-Leor O, Noory E, Ong TK, Unterseeh T, de Araújo Gonçalves P, Zirlik A, Almerri K, Sharif F, Lauder L, Wanten M, Fahy M, Böhm M (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 80

Pages Range: 1871-1880

Journal Issue: 20

DOI: 10.1016/j.jacc.2022.08.802

Abstract

Background: Renal denervation (RDN) has been shown to lower blood pressure (BP), but its effects on cardiovascular events have only been preliminarily evaluated. Time in therapeutic range (TTR) of BP is associated with cardiovascular events. Objectives: This study sought to assess the impact of catheter-based RDN on TTR and its association with cardiovascular outcomes in the GSR (Global SYMPLICITY Registry). Methods: Patients with uncontrolled hypertension were enrolled and treated with radiofrequency RDN. Office and ambulatory systolic blood pressure (OSBP and ASBP) were measured at 3, 6, 12, 24, and 36 months postprocedure and used to derive TTR. TTR through 6 months was assessed as a predictor of cardiovascular events from 6 to 36 months using a Cox proportional hazard regression model. Results: As of March 1, 2022, 3,077 patients were enrolled: 42.2% were female; mean age was 60.5 ± 12.2 years; baseline OSBP was 165.6 ± 24.8 mm Hg; and baseline ASBP was 154.3 ± 18.7 mm Hg. Patients were prescribed 4.9 ± 1.7 antihypertensive medications at baseline and 4.8 ± 1.9 at 36 months. At 36 months, mean changes were −16.7 ± 28.4 and −9.0 ± 20.2 mm Hg for OSBP and ASBP, respectively. TTR through 6 months was 30.6%. A 10% increase in TTR after RDN through 6 months was associated with significant risk reductions from 6 to 36 months of 15% for major adverse cardiovascular events (P < 0.001), 11% cardiovascular death (P = 0.010), 15% myocardial infarction (P = 0.023), and 23% stroke (P < 0.001). Conclusions: There were sustained BP reductions and higher TTR through 36 months after RDN. A 10% increase in TTR through 6 months was associated with significant risk reductions in major cardiovascular events from 6 to 36 months. (Global SYMPLICITY Registry [GSR] DEFINE; NCT01534299)

Authors with CRIS profile

Involved external institutions

University of Milano-Bicocca / Università degli Studi di Milano-Bicocca, UNIMIB Italy (IT) Medical University Gdansk / Gdański Uniwersytet Medyczny Poland (PL) Universitätsklinikum des Saarlandes (UKS) Germany (DE) Hospital Universitario 12 de Octubre Spain (ES) Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH Germany (DE) University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI) Italy (IT) Health Sciences Research Institute of the “Germans Trias i Pujol” Foundation (IGTP) Spain (ES) Dobney Hypertension Centre Australia (AU) Sarawak General Hospital / Hospital Umum Sarawak Malaysia (MY) Medtronic United States (USA) (US) National Taiwan University Hospital (NTUH) / 國立台灣大學醫學院附設醫院 Taiwan (TW) Medizinische Universität Graz Austria (AT) Centro Hospitalar de Lisboa Ocidental E.P.E. (CHLO) Portugal (PT) Birmingham Biomedical Research Centre United Kingdom (GB) Sana Kliniken Lübeck GmbH Germany (DE) Hôpital privé Jacques Cartier France (FR) Chest Diseases Hospital (CDH) Kuwait (KW) National University of Ireland (NUI), Galway Ireland (IE)

How to cite

APA:

Mahfoud, F., Mancia, G., Schmieder, R., Ruilope, L., Narkiewicz, K., Schlaich, M.,... Böhm, M. (2022). Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range. Journal of the American College of Cardiology, 80(20), 1871-1880. https://dx.doi.org/10.1016/j.jacc.2022.08.802

MLA:

Mahfoud, Felix, et al. "Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range." Journal of the American College of Cardiology 80.20 (2022): 1871-1880.

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