Impact of centrally acting sympatholytic agents on the blood pressure response to renal denervation

BACKGROUND: Increased activity of the sympathetic nervous system (SNS) is a critical factor in the pathophysiology of hypertension. Centrally acting sympatholytic agents (CASA) and renal denervation (RDN) represent two distinct therapeutic strategies targeting the SNS. AIMS: This study explored whether the blood pressure (BP)-lowering effect of RDN is influenced by the presence of CASAs. METHODS: Patients from the Global Symplicity Registry (GSR) were categorized into two groups based on whether or not their antihypertensive medication regimen prior to RDN included CASAs. Changes in systolic and diastolic 24-h ambulatory BP from baseline to 3-, 6, 12 and 24-month follow-up were compared between groups with crude and adjusted ANCOVAs. RESULTS: A total of 2712 patients had medication data available at baseline, of whom 1036 (38.2%) were on CASAs, and 1676 (61.8%) were not. Systolic 24-h ambulatory BP lowering at all time points after RDN was consistently more pronounced in the non-CASA compared to the CASA group ( P < 0.001). DBP lowering was greater in the non-CASA group at 3- and 6-month follow-up, but not at later time points. CONCLUSION: Patients not treated with CASAs prior to RDN demonstrated a more pronounced ambulatory SBP reduction over 24 months compared to those on CASA treatment. These findings corroborate the notion that the RDN-induced BP reduction is at least in part mediated via modulation of central sympathetic outflow. Even in the presence of CASAs, RDN still results in significant BP lowering, yet to a lesser degree. These findings have implications for managing patient expectations prior to RDN.