Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial

Weber T, Wassertheurer S, Mayer CC, Hametner B, Danninger K, Townsend RR, Mahfoud F, Kario K, Fahy M, Debruin V, Peterson N, Negoita M, Weber MA, Kandzari DE, Schmieder R, Tsioufis KP, Binder RK, Boehm M (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Hypertension American Heart Association

Book Volume: 79

Pages Range: 1506-1514

Journal Issue: 7

DOI: 10.1161/HYPERTENSIONAHA.121.18641

Abstract

Background: Renal denervation (RDN) lowers blood pressure (BP), but BP response is variable in individual patients. We investigated whether measures of pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, predict BP drop following RDN. Methods: From the randomized, sham-controlled SPYRAL HTN-OFF MED Pivotal trial, we performed a post hoc analysis of BP waveforms from 111 RDN patients and 111 sham controls, obtained with a brachial cuff-based sphygmomanometer. Waveforms were acquired during ambulatory BP monitoring at diastolic BP level and processed with validated ARCSolver algorithms to derive hemodynamic parameters (augmentation index; augmentation pressure; backward and forward wave amplitude; estimated aortic pulse wave velocity). We investigated the relationship between averaged 24-hour values at baseline and the change in 24-hour BP at 3 months in RDN patients, corrected for observed trends in the sham group. Results: There was a consistent inverse relationship between baseline augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity and BP response to RDN: the decrease in 24-hour systolic BP/diastolic BP was 7.8/5.9 (augmentation index), 8.0/6.3 (augmentation pressure), 6.7/5.4 (backward wave amplitude), 5.7/4.7 (forward wave amplitude), and 7.8/5.2 (estimated aortic pulse wave velocity) mm Hg greater for patients below versus above the respective median value (P<0.001 for all comparisons, respectively). Taking augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity into account, a favorable BP response following RDN, defined as a drop in 24-hour systolic blood pressure of >= 5 mm Hg, could be predicted with an area under the curve of 0.70/0.74/0.70/0.65/0.62 (P<0.001 for all, respectively). Conclusions: These results suggest that pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, may predict BP response to RDN.

Authors with CRIS profile

Roland Schmieder Professur für Innere Medizin (Nephrologie)

Involved external institutions

Klinikum Wels-Grieskirchen AT Austria (AT) Universität des Saarlandes (UdS) DE Germany (DE) AIT Austrian Institute of Technology AT Austria (AT) University of Pennsylvania US United States (USA) (US) Jichi Medical University / 自治医科大学 JP Japan (JP) Medtronic US United States (USA) (US) SUNY Downstate Medical Center US United States (USA) (US) Piedmont Healthcare US United States (USA) (US) National and Kapodistrian University of Athens GR Greece (GR)

How to cite

APA:

Weber, T., Wassertheurer, S., Mayer, C.C., Hametner, B., Danninger, K., Townsend, R.R.,... Boehm, M. (2022). Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial. Hypertension, 79(7), 1506-1514. https://doi.org/10.1161/HYPERTENSIONAHA.121.18641

MLA:

Weber, Thomas, et al. "Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial." Hypertension 79.7 (2022): 1506-1514.

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