Radiofrequency-based renal denervation reduced office systolic blood pressure by 6.32 mmHg at 1 year, which was less effective than spironolactone (-12.64 mmHg) (p<0.001).
RCT (n=125)
Does radiofrequency-based renal denervation reduce blood pressure compared to spironolactone or dapagliflozin in patients with resistant hypertension?
Spironolactone remains the most effective adjunctive therapy for resistant hypertension, providing superior blood pressure reduction compared to dapagliflozin and renal denervation at 1 year.
Absolute Event Rate: -6.32% vs -12.64%
p-value: p=<0.001
Objective: Comparative evaluation of the effectiveness of radiofrequency-based renal denervation versus pharmacological treatment in reducing blood pressure in patients with resistant hypertension. Design and method: The study enrolled 125 patients with resistant hypertension who, over a period of 4 weeks, received standardized pharmacological treatment. After confirmation of treatment resistance, the patients were randomized into three research groups according to the therapy added to the previously administered regimen: Group I – Spironolactone, Group II – Dapagliflozin, Group III – renal artery denervation. Patients underwent evaluation at baseline, 6 and 12 months. Renal denervation was performed in the main renal arteries and their branches. Results: Office SBP and DBP values, comparably elevated at baseline, demonstrated a statistically significant reduction beginning at the 6-month evaluation across all study groups, with the maximum effect observed at the end of follow-up. At one year of monitoring, office SBP showed a superior reduction in the spironolactone group (-12.64 ± 0.16 mmHg) compared with dapagliflozin (-5.42 ± 0.09 mmHg) and renal denervation (-6.32± 0.15 mmHg), p < 0.001. A similar pattern was noted for office DBP (-4.7 ± 0.12 mmHg in Group I versus -2.52 ± 0.16 mmHg in Group II and -3.96 ± 0.16 mmHg in Group III, p < 0.001). SBP m/24 h demonstrated a reduction across all three study groups at the 6-month evaluation. By the end of the study, this reduction amounted to -11.26 ± 0.21 mmHg in Group I compared with - 4.44 ± 0.12 mmHg in Group II and -5.84 ± 0.14 mmHg in Group III, p < 0.001. Spironolactone maintained superior efficacy relative to dapagliflozin and renal denervation. In contrast, ambulatory DBP reductions were comparable at 6 months, but by 12 months spironolactone and renal denervation proved superior to dapagliflozin. Conclusions: Renal denervation proved effective in lowering blood pressure in patients with resistant hypertension. Overall, mineralocorticoid receptor blockade with spironolactone remains the most effective adjunctive therapy for resistant hypertension, while renal denervation may serve as a complementary option in selected patients.
Moiseeva et al. (Fri,) conducted a rct in resistant hypertension (n=125). Radiofrequency-based renal denervation vs. Spironolactone and Dapagliflozin was evaluated on Reduction in office systolic blood pressure at 1 year (p=<0.001). Radiofrequency-based renal denervation reduced office systolic blood pressure by 6.32 mmHg at 1 year, which was less effective than spironolactone (-12.64 mmHg) (p<0.001).