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Blood pressure response to renal denervation is correlated with baseline blood pressure variability: a patient-level meta-analysis

Persu, Alexandrea,b,*; Gordin, Danielc,d,*; Jacobs, Lottee; Thijs, Lutgardee; Bots, Michiel, L.f; Spiering, Wilkog; Miroslawska, Atenah,i; Spaak, Jonasj; Rosa, Jánk,l; de Jong, Mark, R.m; Berra, Elenaa,n; Fadl Elmula, Fadl Elmula, M.o; Wuerzner, Gregoirep; Taylor, Alison, H.M.q; Olszanecka, Agnieszkar; Czarnecka, Danutar; Mark, Patrick, B.q; Burnier, Michelp; Renkin, Jeana,b; Kjeldsen, Sverre, E.o; Widimský, Jiřík; Elvan, Arifm; Kahan, Thomasj; Steigen, Terje, K.h; Blankestijn, Peter, J.s; Tikkanen, Ilkkac,t; Staessen, Jan, A.e,uon behalf of the European Network COordinating research on Renal Denervation (ENCOReD)

doi: 10.1097/HJH.0000000000001582
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Background: 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.

Methods: 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).

Results: 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.

Conclusion: 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: jan.staessen@med.kuleuven.be, jan.staessen@maastrichtuniversity.nl

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

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