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.
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.
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.
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: email@example.com
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