Sympathetic tone is one of the main determinants of blood pressure (BP) variability and treatment-resistant hypertension. The aim of our study was to assess changes in BP variability after renal denervation (RDN). In addition, on an exploratory basis, we investigated whether baseline BP variability predicted the BP changes after RDN.
We analyzed 24-h BP recordings obtained at baseline and 6 months after RDN in 167 treatment-resistant hypertension patients (40% women; age, 56.7 years; mean 24-h BP, 152/90 mmHg) recruited at 11 expert centers. BP variability was assessed by weighted SD [SD over time weighted for the time interval between consecutive readings (SDiw)], average real variability (ARV), coefficient of variation, and variability independent of the mean (VIM).
Mean office and 24-h BP fell by 15.4/6.6 and 5.5/3.7 mmHg, respectively (P < 0.001). In multivariable-adjusted analyses, systolic/diastolic SDiw and VIM for 24-h SBP/DBP decreased by 1.18/0.63 mmHg (P ≤ 0.01) and 0.86/0.42 mmHg (P ≤ 0.05), respectively, whereas no significant changes in ARV or coefficient of variation occurred. Furthermore, baseline SDiw (P = 0.0006), ARV (P = 0.01), and VIM (P = 0.04) predicted the decrease in 24-h DBP but not 24-h SBP after RDN.
RDN was associated with a decrease in BP variability independent of the BP level, suggesting that responders may derive benefits from the reduction in BP variability as well. Furthermore, baseline DBP variability estimates significantly correlated with mean DBP decrease after RDN. If confirmed in younger patients with less arterial damage, in the absence of the confounding effect of drugs and drug adherence, baseline BP variability may prove a good predictor of BP response to RDN.
aPole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain
bCliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
cAbdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital
dFolkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
eStudies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
fJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht
gDepartment of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
hDepartment of Cardiology, University Hospital of North Norway, Tromsø
iCardiovascular Diseases Research Group, UiT The Arctic University of Norway, Norway
jKarolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
kThird Department of Internal Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague
lCardiocentre University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
mDepartment of Cardiology, Isala Klinieken, Zwolle, The Netherlands
nDepartment of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy
oDepartment of Cardiology and Department of Acute Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
pService of Nephrology, Lausanne University Hospital, Lausanne, Switzerland
qBHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
r1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
sDepartment of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
tMinerva Institute for Medical Research, Helsinki, Finland
uR&D Group VitaK, Maastricht University, Maastricht, The Netherlands
Correspondence to Jan A. Staessen, MD, PhD, Studies Coordinating Centre, Laboratory of Hypertension, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Box 7001, BE-3000 Leuven, Belgium. E-mail: email@example.com, firstname.lastname@example.org
Abbreviations: ARV, average real variability; BP, blood pressure; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; CV, coefficient of variation; eGFR, estimated glomerular filtration rate; ENCOReD, European Network COordinating research on Renal Denervation; MSNA, muscle sympathetic nerve activity; RDN, renal denervation; rHT, treatment-resistant hypertension; SDw, weighted SD; VIM, variability independent of the mean
Received 19 December, 2016
Revised 13 August, 2017
Accepted 4 September, 2017