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Long-term reduction in morning and nighttime blood pressure after renal denervation: 36-month results from SPYRAL HTN-ON MED trial

Elevated morning and nighttime blood pressures (BP) are associated with increased risk of cardiovascular events such as stroke and myocardial infarction. We compared the long-term changes in morning and nighttime BP in patients with uncontrolled hypertension (office systolic BP between 150 and <1...

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Detalles Bibliográficos
Autores principales: Kario, Kazuomi, Mahfoud, Felix, Kandzari, David E., Townsend, Raymond R., Weber, Michael A., Schmieder, Roland E., Tsioufis, Konstantinos, Pocock, Stuart, Brar, Sandeep, Hettrick, Douglas A., Fahy, Martin, Böhm, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Nature Singapore 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9747613/
https://www.ncbi.nlm.nih.gov/pubmed/36241705
http://dx.doi.org/10.1038/s41440-022-01042-8
Descripción
Sumario:Elevated morning and nighttime blood pressures (BP) are associated with increased risk of cardiovascular events such as stroke and myocardial infarction. We compared the long-term changes in morning and nighttime BP in patients with uncontrolled hypertension (office systolic BP between 150 and <180 mmHg/diastolic BP ≥ 90 mmHg; mean ambulatory systolic BP (SBP) between 140 and <170 mmHg; 1–3 prescribed antihypertensive medications). Eighty patients were randomized to RDN or sham control. In patients taking at least 3 antihypertensive medications at 36 months (N = 23 RDN group; N = 23 sham group), the 24 h ambulatory SBP as well as morning (7:00–9:00AM) and nighttime (1:00–6:00AM) ambulatory SBP were significantly lower for the RDN group compared to sham control (24 h SBP: −20.2 vs. −10.2, p = 0.0087; morning SBP: −23.9 vs. −8.0 mmHg, p = 0.029; nighttime SBP: −20.8 vs. −7.2 mmHg, p = 0.0011). At 36 months, 24 h SBP was controlled to <130 mmHg in 40% of RDN patients in the morning compared to 6% for the sham group; P = 0.021 and in 80% of the RDN patients at night compared to 39% in the sham group; P = 0.019. Major adverse events through 36 months were rare in both groups, and there were no renal artery re-interventions or vascular complications. Morning and nighttime SBP were significantly lower in patients prescribed at least 3 antihypertensive medications at 36 months in the SPYRAL HTN-ON MED trial for RDN compared with sham control. The results suggest RDN has significant benefit when the risk of cardiovascular events is highest.