Higher CF-PWV at baseline tied to BP reduction after RDN

Greater carotid-femoral (CF) pulse-wave velocity (PWV) at baseline appears predictive of a smaller decrease in systolic ambulatory blood pressure (BP) following renal sympathetic denervation (RDN), a prospective, single-arm pilot study has shown.

A group of researchers enrolled patients with systolic office BP at least 140 mm Hg, mean 24-h systolic ambulatory BP at least 130 mm Hg, and at least three prescribed antihypertensive drugs who then underwent radiofrequency RDN.

Temporal evolution of mean 24-h systolic ambulatory BP throughout 1-year post-RDN (measured at baseline and 3‒6‒12 months) served as the primary efficacy endpoint.

The research team assessed effect modification for baseline ultrasound CF and magnetic resonance (MR) PWV, MR aortic distensibility, cardiac MR left ventricular parameters, and clinical variables. They also conducted statistical analyses using linear mixed-effects models and assessed effect modification using interaction terms.

Thirty patients (mean age 62.5 years, 50 percent women), with mean 24-h ambulatory BP of 146.7/80.8 mm Hg, met the inclusion criteria. Their mean 24-h systolic ambulatory BP decreased by 8.4 mm Hg/year (95 percent confidence interval, ‒14.5 to ‒2.3) after RDN (p=0.007).

Independent effect modifiers were as follows: CF-PWV (2.7 mm Hg/year change in outcome for every m/s increase in CF-PWV; p=0.03), daytime diastolic ambulatory BP (‒0.4 mm Hg/year per mm Hg; p=0.03), age (0.6 mm Hg/year per year of age; p=0.006), female sex (‒14.0 mm Hg/year as compared with men; p=0.003), and body mass index (1.2 mm Hg/year per kg/m²; p=0.04).

“These findings could contribute to improve identification of RDN responders,” the researchers said.