Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry

Aims : Catheter-based renal artery denervation (RDN) has been shown to lower blood pressure (BP) in certain patients with uncontrolled hypertension. Isolated systolic hypertension (ISH) (systolic BP [SBP] >= 140 mmHg and diastolic BP < 90 mmHg), characterized by increased vascular stiffness, is the predominant hypertensive phenotype in elderly patients. This study compared baseline characteristics and SBP change at 6 months between patients with ISH and combined systolic-diastolic hypertension (CH). Methods and results This study pooled data from 1103 patients from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. A total of 429 patients had ISH, and 674 had CH. Patients with ISH were significantly older than those with CH (66 vs. 55 years), had more type 2 diabetes mellitus (52.9 vs. 34.6%), and a lower estimated glomerular filtration rate (71.8 vs. 78.6 mL/min/ 1.73 m(2)); all P < 0.001. At 6 months, the SBP drop for CH patients was -18.7 +/- 23.7 mmHg compared with a reduction of -10.9 +/- 21.7 mmHg for ISH patients 27.8 mmHg, 95% confidence interval, CI, 210.5, 25.1, P, 0.001). The change in 24- h SBP at 6 months was -8.8 +/- 16.2 mmHg in patients with CH vs. -5.8 +/- 15.4 mmHg in ISH ( -3.0 mmHg, 95% CI -5.4, -0.6, P = 0.015). Presence of ISH at baseline but not age was associated with less pronounced BP changes following the procedure. The strongest predictor of office SBP reduction at 6 months was CH, followed by aldosterone antagonist use and non-use of vasodilators. Conclusion The reduction in BP among patients with ISH following RDNwas less pronounced than the reduction in patientswith CH.