Key result
Renal denervation and spironolactone addition produced comparable reductions in 24-hour systolic blood pressure (9.1 mmHg vs 10.9 mmHg) in patients with true resistant hypertension.
Why the study?
Does renal denervation reduce blood pressure compared to spironolactone addition in patients with true resistant hypertension?
RCT (n=106)
randomized
Yes
Does renal denervation reduce blood pressure compared to spironolactone addition in patients with true resistant hypertension?
Mean Difference: 3.7
Absolute Event Rate: 9.1% vs 10.9%
p-value: p=0.27
In patients with true resistant hypertension, spironolactone addition provided comparable or slightly better blood pressure reduction than renal denervation over 24 months.
Renal denervation matches spironolactone addition for 24-hour SBP reduction in true resistant hypertension; extends evidence-based options beyond pharmacotherapy.
OBJECTIVES: The randomized, multicentre study compared the efficacy of renal denervation (RDN) versus spironolactone addition in patients with true resistant hypertension. We present the 24-month data. METHODS: A total of 106 patients with true resistant hypertension were enrolled in this study: 52 patients were randomized to RDN and 54 patients to the spironolactone addition, with baseline SBP of 159 ± 17 and 155 ± 17 mmHg and average number of drugs 5.1 and 5.4, respectively. Two-year data are available in 86 patients. Spironolactone addition, as crossover after 1 year, was performed in 23 patients after RDN, and spironolactone addition followed by RDN was performed in five patients. RESULTS: Similar and comparable reduction of 24-h SBP after RDN or spironolactone addition after randomization was observed, 9.1 mmHg (P = 0.001) and 10.9 mmHg (P = 0.001), respectively. Similar decrease of office blood pressure (BP) was observed, 17.7 mmHg (P < 0.001) versus 14.1 mmHg (P < 0.001), whereas the number of antihypertensive drugs did not differ significantly between groups. Crossover analysis showed nonsignificantly better efficacy of spironolactone addition in 24-h SBP and office SBP reduction than RDN (3.7 mmHg, P = 0.27 and 4.6 mmHg, P = 0.28 in favour of spironolactone addition, respectively). Meanwhile, the number of antihypertensive drugs was significantly increased after spironolactone addition (+0.7, P = 0.001). CONCLUSION: In the settings of true resistant hypertension, spironolactone addition (if tolerated) seems to be of better efficacy than RDN in BP reduction over a period of 24 months. However, by contrast to the 12-month results, BP changes were not significantly greater.
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Rosa et al. (2017) conducted an RCT in true resistant hypertension (n=106). Renal denervation vs. Spironolactone addition was evaluated on Reduction of 24-h systolic blood pressure (MD 3.7, p=0.27). Renal denervation and spironolactone addition produced comparable reductions in 24-hour systolic blood pressure (9.1 mmHg vs 10.9 mmHg) in patients with true resistant hypertension.
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