Radiofrequency renal denervation in patients with hypertension-mediated organ damage achieved mean office and 24-h ambulatory systolic BP reductions of 15.0 mmHg and 10.6 mmHg at 3 years.
Observational (n=1,183)
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Does radiofrequency renal denervation reduce blood pressure in patients with hypertension-mediated organ damage?
Radiofrequency renal denervation achieved significant and sustained blood pressure reductions over 3 years in patients with hypertension-mediated organ damage, without requiring additional antihypertensive medications.
Objective: Patients with hypertension may develop hypertension mediated organ damage (HMOD), usually in the heart, brain, eyes, kidneys and blood vessels. Patients with HMOD have higher risk of cardiovascular events and need intensified blood pressure (BP) management to prevent further disease progression. Renal denervation (RDN) may be an effective adjunctive BP-lowering therapy to antihypertensive medications in patients with HMOD. Design and method: The Global SYMPLICITY Registry DEFINE (GSR DEFINE) is the largest, real-world registry of patients undergoing RDN. All patients enrolled had radiofrequency (RF) RDN with either Flex™ or Spyral™ device (Medtronic Plc). We evaluated patients with HMOD defined as: >=1 following baseline characteristics from clinical history: left ventricular hypertrophy (LVH), hypertensive retinopathy, peripheral artery disease, microalbuminuria, or estimated glomerular filtrate rate (eGFR) <60 ml/min/1.73m2. BP, eGFR, antihypertensive medications, and adverse events were evaluated through 3yrs. Results: As of March 2025, 3,929 patients were enrolled in GSR DEFINE. 1,183 (30.1%) patients met the definition of HMOD. Patients were 63±12yrs old, 43.7% female. The most common HMOD characteristic was eGFR <60 ml/min/1.73m2 (43.8%), followed by LVH (38.9%), microalbuminuria (17.0%), peripheral artery disease (12.7%), and hypertensive retinopathy (5.5%). Baseline office and 24-h ambulatory systolic BP (SBP) was 166±25 mmHg and 156±19 mmHg, respectively. Through 3yrs, there was a progressive decline in office and 24-h ambulatory SBP. At 3yrs, mean office and 24-h ambulatory SBP changes were -15.0±28.9 mmHg and -10.6±21.6 mmHg, respectively (Figure). The number of antihypertensive medications did not increase (baseline 5.0±1.5 to 4.7±1.6 at 3yrs). The mean eGFR at baseline and 3yrs was 61 and 57 ml/min/1.73m2, respectively. Total cumulative adverse events at 3yrs were 4.9% cardiovascular death, 3.3% myocardial infarction, 5.7% stroke, and 7.0% hospitalization with new heart failure. Conclusions: In GSR DEFINE, a large proportion of patients had HMOD, most commonly with renal disease and/or cardiac structural abnormality such as LVH. Through 3yrs, RF RDN achieved significant BP reductions, without increasing antihypertensive medications, with stable renal function. Further study is warranted to evaluate whether BP reduction and other autonomic effects of RDN may slow HMOD disease progression.
Mahfoud et al. (Fri,) conducted a observational in Hypertension with hypertension-mediated organ damage (n=1,183). Radiofrequency renal denervation was evaluated on Mean office systolic blood pressure change at 3 years. Radiofrequency renal denervation in patients with hypertension-mediated organ damage achieved mean office and 24-h ambulatory systolic BP reductions of 15.0 mmHg and 10.6 mmHg at 3 years.