Does Renal Denervation Lower Nighttime BP?

Nocturnal hypertension (HTN) is associated with cardiovascular (CV) risk and is common in chronic kidney disease (CKD). To help determine whether renal denervation (RDN) can lower nighttime blood pressure (BP) in patients with CKD and HTN, Markus Schlaich and others studied patients with uncontrolled HTN in the Global SYMPLICITY Registry (GSR) DEFINE. Their findings were presented at the National Kidney Foundation Spring Clinical Meetings.

There were 3331 patients enrolled in the study. All had uncontrolled BP and 24.2% had CKD. Those with CKD were 64 ± 12 years of age, 47.3% female, 54.9% with diabetes, and 56.9% with cardiac disease. Of those patients, 12.3% had an estimated glomerular filtration rate (eGFR) <30. The baseline nighttime systolic BP (NSBP) was higher for patients with CKD versus those without CKD (149 ± 23 mmHg vs 145 ± 21 mmHg; P=.0002), while they were prescribed 5.2 ± 1.7 versus 4.8 ± 1.7 (P<.0001) antihypertensive drugs, respectively.

All participants had radiofrequency RDN and were grouped by eGFR (mL/min/1.73m²): <60 (CKD) or ≥60 (non-CKD). After 3 years of RDN, changes in NSBP were compared. NSBP declined significantly among those with CKD (−7.8 mmHg); this was similar to the non-CKD patients (−8.4 mmHg). Changes in eGFR were similar in both groups (CKD, −4.7 ± 17.4 vs non-CKD, −7.0 ± 17.0; P=.34). Daytime systolic BP, sodium, potassium, and creatinine changes were not significantly different between the CKD and non-CKD groups.

In sum, the researchers noted that, “RDN in addition to drugs may help to reduce risk of long-term CV events in this high-risk cohort.”

Source: Schlaich M, Mahfoud F, Narkiewicz K, et al. Three-year nighttime blood pressure after radiofrequency renal denervation in patients with uncontrolled hypertension and chronic kidney disease. Presented at the National Kidney Foundation Spring Clinical Meetings 2024; May 14-18, 2024; Long Beach, California.