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Hyperresponders vs. nonresponder patients after renal denervation: do they differ?

Persu, Alexandrea,b; Azizi, Michelc; Jin, Yud; Volz, Sebastiane; Rosa, Janf; Fadl Elmula, Fadl Elmula M.g; Pechere-Bertschi, Antoinetteh; Burnier, Micheli; Mark, Patrick B.j; Elvan, Arifk; Renkin, Jeana,b; Sapoval, Marcc; Kahan, Thomasl; Kjeldsen, Sverreg; Staessen, Jan A.d,m; the European Network COordinating research on Renal Denervation (ENCOReD) consortium

doi: 10.1097/HJH.0000000000000347
ORIGINAL PAPERS: Resistant hypertension

Background: Blood pressure (BP) response after renal denervation (RDN) is highly variable. Besides baseline BP, no reliable predictors of response have been consistently identified. The differences between patients showing a major BP decrease after RDN vs. nonresponders have not been studied so far.

Aim and methods: We identified extreme BP responders (first quintile) and nonresponders (fifth quintile) to RDN defined according to office or 24-h ambulatory BP in the European Network COordinating research on Renal Denervation database (n = 109) and compared the baseline characteristics and BP changes 6 months after RDN in both subsets.

Results: In extreme responders defined according to ambulatory BP, baseline BP and BP changes 6 months after RDN were similar for office and out-of-the office BP. In contrast, extreme responders defined according to office BP were characterized by a huge white-coat effect at baseline, with dramatic shrinkage at 6 months. Compared with nonresponders, extreme responders defined according to office BP were more frequently women, had higher baseline office – but not ambulatory – BP, and higher estimated glomerular filtration rate (eGFR). In contrast, when considering ambulatory BP decrease to define extreme responders and nonresponders, the single relevant difference between both subsets was baseline ambulatory BP.

Conclusion: This study suggests a major overestimation of BP response after RDN in extreme responders defined according to office, but not ambulatory BP. The association of lower eGFR with poor response to RDN is consistent with our previous analysis. The increased proportion of women in extreme responders may reflect sex differences in drug adherence.

aPole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain

bDivision of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

cAssistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou and Université Paris Descartes, Paris, France

dStudies Coordinating Center, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, Leuven, Belgium

eDepartment of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden

fThird Department of Internal Medicine, General Faculty Hospital, Prague, Czech Republic

gDepartment of Cardiology, Ullevaal University Hospital, University of Oslo, Oslo, Norway

hDepartment of Cardiology, Geneva University Hospitals, Geneva

iDepartment of Nephrology, Lausanne University Hospital, Lausanne, Switzerland

jBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom

kDepartment of Cardiology, Isala Klinieken, Zwolle, the Netherlands

lKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden

mDepartment of Epidemiology, Maastricht University, Maastricht, the Netherlands

Correspondence to Alexandre Persu, MD, PhD, Cardiology Department, Cliniques Universitaires Saint Luc (UCL), 10 Avenue Hippocrate, 1200, Brussels, Belgium. Tel: +32 2 764 63 06; fax: +32 2 764 89 80; e-mail: alexandre.persu@uclouvain.be

Abbreviations: BP, blood pressure; eGFR, estimated glomerular filtration rate; ENCOReD, European Network COordinating research on Renal Denervation; RDN, renal denervation

Received 15 April, 2014

Revised 16 July, 2014

Accepted 16 July, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins