Key result
RDN shows no BP benefit over control and baseline sodium fails to predict response.
Why the study?
Predictors of the blood pressure-lowering effect of renal denervation in resistant hypertension have not been identified beyond office systolic blood pressure, and the role of dietary sodium intake is unclear.
Does baseline sodium excretion predict the blood pressure response to percutaneous renal denervation in patients with resistant hypertension?
RCT
Does baseline sodium excretion predict the blood pressure response to percutaneous renal denervation in patients with resistant hypertension?
Baseline sodium excretion does not predict the blood pressure-lowering effect of renal denervation, and apparent changes in salt sensitivity are not attributable to the procedure.
Baseline sodium excretion should not guide renal denervation selection; leaves open procedure efficacy versus controls in hypertension.
The effect of lowering sympathetic nerve activity by renal denervation (RDN) is highly variable. With the exception of office systolic blood pressure (BP), predictors of the BP-lowering effect have not been identified. Because dietary sodium intake influences sympathetic drive, and, conversely, sympathetic activity influences salt sensitivity in hypertension, we investigated 24-hour urinary sodium excretion in participants of the SYMPATHY trial. SYMPATHY investigated RDN in patients with resistant hypertension. Both 24-hour ambulatory and office BP measurements were end points. No relationship was found for baseline sodium excretion and change in BP 6 months after RDN in multivariable-adjusted regression analysis. Change in the salt intake-measured BP relationships at 6 months vs baseline was used as a measure for salt sensitivity. BP was 8 mm Hg lower with similar salt intake after RDN, suggesting a decrease in salt sensitivity. However, the change was similar in the control group, and thus not attributable to RDN.
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Beus et al. (2017) conducted an RCT in Resistant hypertension. Renal denervation (RDN) vs. Control group was evaluated on 24-hour ambulatory and office BP measurements. Baseline sodium excretion did not predict blood pressure change 6 months after renal denervation, and the observed 8 mm Hg reduction in BP was similar to the control group.
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