Outcomes Following Radiofrequency Renal Denervation According to Antihypertensive Medications: Subgroup Analysis of the Global SYMPLICITY Registry DEFINE

Mahfoud F, Mancia G, Schmieder R, Ruilope L, Narkiewicz K, Schlaich M, Williams B, Ribichini F, Weil J, Almerri K, Sharif F, Lauder L, Wanten M, Fahy M, Böhm M (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Hypertension American Heart Association

Book Volume: 80

Pages Range: 1759-1770

Journal Issue: 8

DOI: 10.1161/HYPERTENSIONAHA.123.21283

Abstract

BACKGROUND: The Global SYMPLICITY Registry DEFINE (Denervation Findings in Real World) investigates radiofrequency renal denervation (RDN) in a broad range of patients with hypertension. We evaluated whether the number or type of antihypertensive medications were associated with increased long-term blood pressure (BP) reductions and cardiovascular outcomes following radiofrequency RDN. METHODS: Patients underwent radiofrequency RDN and were categorized by baseline number (0-3 and ≥4) and different combinations of medication classes. BP changes were compared between groups through 36 months. Individual and composite major adverse cardiovascular events were analyzed. RESULTS: Of 2746 evaluable patients, 18% were prescribed 0 to 3 and 82% prescribed ≥4 classes. At 36 months, office systolic BP significantly decreased (P<0.0001) by -19.0±28.3 and -16.2±28.6 mm Hg in the 0 to 3 and ≥4 class groups, respectively. Twenty-four-hour mean systolic BP significantly decreased (P<0.0001) by -10.7±19.7 and -8.9±20.5 mm Hg, respectively. BP reduction was similar between the medication subgroups. Antihypertensive medication classes decreased from 4.6±1.4 to 4.3±1.5 (P<0.0001). Most decreased (31%) or had no changes (47%) to the number of medications, while 22% increased. The number of baseline antihypertensive medication classes was inversely related to the change in prescribed classes at 36 months (P<0.001). Cardiovascular event rates were generally low. More patients in the ≥4 compared with 0 to 3 medication classes had myocardial infarction at 36 months (2.8% versus 0.3%; P=0.009). CONCLUSIONS: Radiofrequency RDN reduced BP safely through 36 months, independent of the number and type of baseline antihypertensive medication classes. More patients decreased than increased their number of medications. Radiofrequency RDN is a safe and effective adjunctive therapy regardless of antihypertensive medication regimen. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01534299.

Authors with CRIS profile

Roland Schmieder Medizinische Fakultät

Involved external institutions

Universitätsklinikum des Saarlandes (UKS) DE Germany (DE) University of Milano-Bicocca / Università degli Studi di Milano-Bicocca, UNIMIB IT Italy (IT) Dobney Hypertension Centre AU Australia (AU) Birmingham Biomedical Research Centre GB United Kingdom (GB) Sana Kliniken Lübeck GmbH DE Germany (DE) Hospital Universitario 12 de Octubre ES Spain (ES) Medtronic US United States (USA) (US) Chest Diseases Hospital (CDH) KW Kuwait (KW) Medical University Gdansk / Gdański Uniwersytet Medyczny PL Poland (PL) National University of Ireland (NUI), Galway IE Ireland (IE) University Hospital of Verona / Azienda Ospedaliera Universitaria Integrata Verona (AOUI) IT Italy (IT)

How to cite

APA:

Mahfoud, F., Mancia, G., Schmieder, R., Ruilope, L., Narkiewicz, K., Schlaich, M.,... Böhm, M. (2023). Outcomes Following Radiofrequency Renal Denervation According to Antihypertensive Medications: Subgroup Analysis of the Global SYMPLICITY Registry DEFINE. Hypertension, 80(8), 1759-1770. https://dx.doi.org/10.1161/HYPERTENSIONAHA.123.21283

MLA:

Mahfoud, Felix, et al. "Outcomes Following Radiofrequency Renal Denervation According to Antihypertensive Medications: Subgroup Analysis of the Global SYMPLICITY Registry DEFINE." Hypertension 80.8 (2023): 1759-1770.

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