Two-year nighttime blood pressure changes after radiofrequency renal denervation: pooled results from the SPYRAL HTN trials

Kario K, Kandzari DE, Mahfoud F, Weber MA, Schmieder R, Tsioufis K, Liu M, Böhm M, Townsend RR (2025)

Publication Type: Journal article

Publication year: 2025

Journal

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

DOI: 10.1038/s41440-025-02186-z

Abstract

Elevated nighttime blood pressure (BP) and abnormal circadian dipping patterns are associated with advanced age and coexisting illnesses and are attributed to autonomic dysfunction. Radiofrequency renal denervation (RF RDN) effectively lowers BP throughout 24 h and thus may provide an effective antihypertensive therapeutic option. This analysis assesses the effects of RDN on nocturnal hypertension with different dipper patterns defined by nighttime/daytime BP ratio (i.e. dippers, non-dippers, risers) through 2 years in patients randomized to RDN from the SPYRAL HTN-OFF MED and -ON MED trials. Office and 24-h ambulatory BP, were also evaluated in patients stratified by age, obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Among 388 patients, the baseline nighttime systolic BP (SBP) was 139.3 ± 11.3 mmHg. Patients with a riser pattern had the highest baseline nighttime SBP (152.7 ± 8.0 mmHg). At 2 years, patients experienced a significant reduction from baseline (p < 0.0001) in nighttime (−12.0 ± 17.1 mmHg), morning (−14.8 ± 20.0 mmHg), daytime (−13.8 ± 14.7 mmHg), and 24-h SBP (−13.4 ± 14.2 mmHg). The greatest reduction in SBP was in risers at nighttime (−23.7 ± 14.3 mmHg). RDN was equally effective in lowering nighttime BP in patients ≥65 years old or with OSA, CKD, or T2DM. In this pooled dataset of RF RDN patients, clinically meaningful reductions in BP over a 24-h period were observed through 2 years irrespective of dipping status. RF RDN may reduce the risk of cardiovascular outcomes in patients with uncontrolled hypertension, especially in those with elevated nighttime BP who may be the most challenging to treat. (Figure presented.)

Authors with CRIS profile

Roland Schmieder Medizinische Fakultät

Involved external institutions

Jichi Medical University / 自治医科大学 JP Japan (JP) Piedmont Healthcare US United States (USA) (US) Universitätsspital Basel CH Switzerland (CH) SUNY Downstate Health Sciences University US United States (USA) (US) National and Kapodistrian University of Athens GR Greece (GR) Medtronic US United States (USA) (US) Universitätsklinikum des Saarlandes (UKS) DE Germany (DE) University of Pennsylvania (UPenn) US United States (USA) (US)

How to cite

APA:

Kario, K., Kandzari, D.E., Mahfoud, F., Weber, M.A., Schmieder, R., Tsioufis, K.,... Townsend, R.R. (2025). Two-year nighttime blood pressure changes after radiofrequency renal denervation: pooled results from the SPYRAL HTN trials. Hypertension Research. https://doi.org/10.1038/s41440-025-02186-z

MLA:

Kario, Kazuomi, et al. "Two-year nighttime blood pressure changes after radiofrequency renal denervation: pooled results from the SPYRAL HTN trials." Hypertension Research (2025).

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