Key result
Spironolactone was more effective than sympathetic renal denervation in reducing daytime systolic and diastolic blood pressure (P=0.006), but renal denervation reduced diastolic BP variability.
Why the study?
Does sympathetic renal denervation improve circadian BP and BP variability compared to spironolactone in patients with resistant hypertension?
RCT (n=24)
randomized
Does sympathetic renal denervation improve circadian BP and BP variability compared to spironolactone in patients with resistant hypertension?
While spironolactone is more effective at reducing ambulatory blood pressure in resistant hypertension, sympathetic renal denervation provides a greater reduction in diastolic blood pressure variability.
Spironolactone remains preferred over renal denervation for BP reduction in resistant hypertension; extends evidence on differential variability effects.
BACKGROUND Sympathetic renal denervation (SRD) has been proposed as a therapeutic alternative for patients with resistant hypertension not controlled on pharmacological therapy. Two studies have suggested an effect of SRD in reducing short-term blood pressure variability (BPV). However, this has not been addressed in a randomized comparative trial. We aimed to compare the effects of spironolactone and SRD on circadian BP and BPV. METHODS This is a post-hoc analysis of a randomized trial in 24 true resistant hypertensive patients (15 men, 9 women; mean age 64 years) comparing 50mg of spironolactone (n = 13) vs. SRD (n = 11) on 24-hour BP. We report here the comparative effects on daytime (8 am–10 pm) and nighttime (0 am–6 am) BP, night-to-day ratios and BP and heart rate variabilities (SD and coefficient of variation of 24-hour, day and night, as well as weighted SD and average real variability (ARV)). RESULTS Spironolactone was more effective than SRD in reducing daytime systolic (P = 0.006), daytime diastolic (P = 0.006), and nighttime systolic (P = 0.050) BP. No differences were observed in the night-to-day ratios. In contrast, SRD-reduced diastolic BPV (24 hours, daytime, nighttime, weighted, and ARV; all P < 0.05) with respect to spironolactone, without significant differences in systolic BPV. CONCLUSION Spironolactone is more effective than SRD in reducing ambulatory BP. However, BPV is significantly more reduced with SRD. This effect could be important in terms of potential prevention beyond BP reduction and deserves further investigation.
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Sierra et al. (2016) conducted an RCT in resistant hypertension (n=24). Sympathetic renal denervation (SRD) vs. Spironolactone 50mg was evaluated on daytime and nighttime BP, night-to-day ratios and BP and heart rate variabilities (p=0.006). Spironolactone was more effective than sympathetic renal denervation in reducing daytime systolic and diastolic blood pressure (P=0.006), but renal denervation reduced diastolic BP variability.
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