Radiofrequency renal denervation reduced the cumulative mean incidence of hypertensive urgencies compared to sham at 3 years (0.21 vs 0.39 per patient; HR 0.60; 95% CI 0.40-0.90; p=0.014).
RCT
Yes
Does radiofrequency renal denervation reduce hypertensive urgencies and associated healthcare costs in patients with uncontrolled hypertension?
Radiofrequency renal denervation significantly reduces the incidence of hypertensive urgencies compared to sham, potentially leading to substantial healthcare cost savings.
Hazard Ratio: 0.6 (95% CI 0.4–0.9)
Absolute Event Rate: 0.21% vs 0.39%
p-value: p=0.014
Objective: Renal denervation (RDN) lowers blood pressure (BP) in patients with uncontrolled hypertension and may reduce complications, including emergency department (ED) and inpatient (IP) utilization due to hypertensive urgencies. Using data from the SPYRAL HTN-ON and -OFF MED trials, we compared the incidence of hypertensive urgency following RDN versus sham and estimated potential annual cost reductions in two European healthcare systems reflecting differences in local cost structures, utilization, and patterns of care. Design and method: Patients enrolled in the trials had office systolic BP (SBP)/diastolic BP of 150-180/90+ mmHg, 24-h ambulatory SBP of 140-170 mmHg, and were randomized to radiofrequency RDN or sham, without significant differences between groups at baseline. Hypertensive urgency was defined as office BP of 180/120+ mmHg. Hypertensive urgency events through 3 years were analyzed using a Cox regression model. Based on results of two meta-analyses including global data, 0.5% of all ED visits were for hypertensive emergencies, and 64.1% of those were classified as hypertensive urgency events. Among the urgency events, 15.8% resulted in an IP admission. Local cost data were obtained for Spain and Germany, where the cost of hypertension-related ED visits was estimated at €277 and €151, and that of hypertension-related IP admissions was estimated at €2,350 and €2,248, respectively. Potential annual cost savings were modeled by combining trial results, urgency-related utilization estimates, local cost data, and the assumed adoption of RDN based on patient preference models. Results: After 3 years, the cumulative mean hypertensive urgency incidence was 0.21 vs 0.39 per patient in RDN vs sham, respectively (HR 0.60 95% CI: 0.40, 0.90; p=0.014), despite a lower antihypertensive medication burden in the RDN group (3.7±4.3 vs 6.0±11.2; p=0.003). Assuming an RDN adoption rate ranging from 5% to 50%, across both countries, the annual potential hypertensive urgency-related healthcare cost reductions ranged from approximately €1.5 million - €15.5 million (Spain) and €0.6 million - €6.0 million (Germany). Conclusions: RDN treatment reduces the incidence of hypertensive urgencies and may lead to significant reductions in associated IP and ED expenditure in the Spanish and German healthcare settings.
Bohm et al. (Fri,) conducted a rct in Uncontrolled hypertension. Radiofrequency renal denervation vs. Sham was evaluated on Cumulative mean hypertensive urgency incidence per patient (HR 0.60, 95% CI 0.40, 0.90, p=0.014). Radiofrequency renal denervation reduced the cumulative mean incidence of hypertensive urgencies compared to sham at 3 years (0.21 vs 0.39 per patient; HR 0.60; 95% CI 0.40-0.90; p=0.014).