Preprocedural Features of Patients Under Antihypertensive Drugs May Help Identify Responders to Renal Denervation: a Hypothesis-generating Study

Renal denervation (RDN) is effective to lower systolic blood pressure (SBP) in essential hypertension. However, patient selection under medications remains an important unmet clinical need. This multicenter study aimed at observing whether preprocedural features associated with increased renin-angiotensin-aldosterone activity influence RDN response. This study enrolled the patients who underwent RDN for uncontrolled hypertension. Medical records were reviewd and patients were divided into 2 groups depending by meeting any of the following conditions prior to RDN: (1) $>$10 mmHg of office SBP reduction after aldosterone inhibition, (2) aldosterone-renin ratio $>$30 or (3) slow flow on the renal angiogram. RDN responders were defined by a reduction in 24-hour mean $\ge$6 mmHg or by $\ge$1 class of antihypertensive drug withdraw. A total of 46 patients were enrolled, of which 27 (59%) were in control group A and 19 (41%) in group B. The baseline age, gender, office and 24-hour SBP (mean 140.0 $\pm$ 12.8 mmHg vs. 144.0 $\pm$ 16.5 mmHg, p = 0.577) were comparable, while the number of prescribed drug classes was fewer in group A (4.0 $\pm$ 1.3 vs. 4.9 $\pm$ 0.9, p = 0.014). The proportion patients with prescribed aldosterone antagonist or high aldosterone-renin ratios were higher in group B. At 12 months post RDN, the results were significantly better in group B in terms of mean change in office SBP (12.4 $\pm$ 23.5 mmHg vs. 29.9 $\pm$ 25.5 mmHg, p = 0.046) and the proportion of RDN responders (51.9% vs. 89.5%, p $<$ 0.001). RDN was more effective in patients with any of 3 clinical indices.