Novel approaches to define responders to interventional treatment in hypertension: insights from the SPYRAL HTN-OFF and HTN-ON MED trials

Schmieder R, Hettrick DA, Böhm M, Kandzari DE, Kario K, Mahfoud F, Tsioufis K, Weber MA, Esler MD, Townsend RR (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Hypertension Research Nature Publishing Group: Open Access Hybrid Model Option A

Book Volume: 48

Pages Range: 327–335

DOI: 10.1038/s41440-024-01949-4

Abstract

Multiple sham-controlled clinical trials have demonstrated significant reductions in both office and 24-h blood pressure (BP) following radiofrequency renal denervation (RDN) in the uncontrolled hypertension population. Notably, the blood pressure response varies widely within individual participants, thus showing a clinical need to identify potential RDN “responders” prior to the procedure. Despite multiple analytic efforts, no single parameter, aside from baseline blood pressure, has been consistently associated with BP reduction following RDN. However, this failure may be due to limitations in empiric definitions of responders. Indeed, commonly applied responder definitions based on the difference between two point-in-time BP measurements are fraught due to visit-to-visit variability in office and 24-h blood pressure endpoints. Several factors should be considered to develop a more clinically useful operational definition of procedural response including relative changes in office and 24-h BP, consideration of the temporal response to RDN, as well as adjustment for baseline BP. The current evidence may provide incentives for future expert consensus to precisely define responders to hypertension treatments. (Figure presented.)

Authors with CRIS profile

Roland Schmieder Professur für Innere Medizin (Nephrologie)

Involved external institutions

SUNY Downstate Health Sciences University US United States (USA) (US) Piedmont Healthcare US United States (USA) (US) Medtronic US United States (USA) (US) Baker Idi Heart And Diabetes Institute AU Australia (AU) Perelman School of Medicine University of Pennsylvania US United States (USA) (US) Universitätsspital Basel CH Switzerland (CH) National and Kapodistrian University of Athens GR Greece (GR) Universitätsklinikum des Saarlandes (UKS) DE Germany (DE) Jichi Medical University / 自治医科大学 JP Japan (JP)

How to cite

APA:

Schmieder, R., Hettrick, D.A., Böhm, M., Kandzari, D.E., Kario, K., Mahfoud, F.,... Townsend, R.R. (2025). Novel approaches to define responders to interventional treatment in hypertension: insights from the SPYRAL HTN-OFF and HTN-ON MED trials. Hypertension Research, 48, 327–335. https://doi.org/10.1038/s41440-024-01949-4

MLA:

Schmieder, Roland, et al. "Novel approaches to define responders to interventional treatment in hypertension: insights from the SPYRAL HTN-OFF and HTN-ON MED trials." Hypertension Research 48 (2025): 327–335.

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