Hyperresponders vs. nonresponder patients after renal denervation: do they differ?

Alexandre Persu*, Michel Azizi, Yu Jin, Sebastian Volz, Jan Rosa, Fadl Elmula M. Fadl Elmula, Antoinette Pechere-Bertschi, Michel Burnier, Patrick B. Mark, Arif Elvan, Jean Renkin, Marc Sapoval, Thomas Kahan, Sverre Kjeldsen, Jan A. Staessen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

30 Citations (Web of Science)

Abstract

Background: Blood pressure (BP) response after renal denervation (RDN) is highly variable. Besides baseline BP, no reliable predictors of response have been consistently identified. The differences between patients showing a major BP decrease after RDN vs. nonresponders have not been studied so far. Aim and methods: We identified extreme BP responders (first quintile) and nonresponders (fifth quintile) to RDN defined according to office or 24-h ambulatory BP in the European Network COordinating research on Renal Denervation database (n = 109) and compared the baseline characteristics and BP changes 6 months after RDN in both subsets. Results: In extreme responders defined according to ambulatory BP, baseline BP and BP changes 6 months after RDN were similar for office and out-of-the office BP. In contrast, extreme responders defined according to office BP were characterized by a huge white-coat effect at baseline, with dramatic shrinkage at 6 months. Compared with nonresponders, extreme responders defined according to office BP were more frequently women, had higher baseline office - but not ambulatory - BP, and higher estimated glomerular filtration rate (eGFR). In contrast, when considering ambulatory BP decrease to define extreme responders and nonresponders, the single relevant difference between both subsets was baseline ambulatory BP. Conclusion: This study suggests a major overestimation of BP response after RDN in extreme responders defined according to office, but not ambulatory BP. The association of lower eGFR with poor response to RDN is consistent with our previous analysis. The increased proportion of women in extreme responders may reflect sex differences in drug adherence.
Original languageEnglish
Pages (from-to)2422-2427
JournalJournal of Hypertension
Volume32
Issue number12
DOIs
Publication statusPublished - Dec 2014

Keywords

  • ambulatory blood pressure
  • renal denervation
  • resistant hypertension
  • responders

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