Effect of Catheter-Based Renal Denervation on Orthostatic Blood Pressure Adaptations in Patients With Uncontrolled Hypertension

Objective: Abnormal orthostatic blood pressure (BP) adaptation is associated with the risk of adverse cardiovascular events. This study aimed to evaluate the effect of catheter-based renal denervation (RDN) on orthostatic BP adaptation in patients with uncontrolled hypertension.Design and method: This prospective observational study enrolled patients who had been previously included in the multicenter Iberis-HTN trial and NetrodTM-HTN trial. Eligible patients were randomly assigned to undergo either radiofrequency RDN or a sham procedure. BP and heart rate (HR) changes during a 3-min orthostatic challenge from supine to standing were measured at baseline and 6 months after randomization. Results: At 6 months, the RDN group exhibited a significantly greater reduction in ambulatory blood pressure, office systolic blood pressure (SBP) and BP in both supine and standing positions compared to the sham group. After adjusting for baseline values, the magnitude of changes in orthostatic SBP and diastolic blood pressure (DBP) at the 3-minute timepoint, along with the maximum changes observed throughout the 3-minute orthostatic test, was significantly smaller in the RDN group than in the sham group at 6 months (3 min: SBP -7.9 mmHg [95%CI: -13.6 to -2.3], P = 0.008; DBP -6.8 mmHg [95%CI: -11.8 to -1.8], P = 0.010. Maximum: SBP -9.8 mmHg [95%CI: -19.1 to -0.4], P = 0.041; DBP -9.3 mmHg [95%CI: -15.3 to -3.2], P = 0.004). The changes in orthostatic HR at 6 months were comparable between the RDN and the sham group. Conclusions: Catheter-based radiofrequency RDN significantly reduced office BP, ambulatory BP, and BP in both supine and standing positions during active standing at 6 months compared to the sham group. Additionally, RDN attenuated the inappropriate elevation in orthostatic BP and partially restored the normal response pattern to orthostatic challenges.