Systolic blood pressure time in the target range after renal denervation: relationship with the neurohormonal profile of patients with resistant hypertension

Introduction. Systolic blood pressure (SBP) time in target range (TTR) is a predictor of cardiovascular outcomes. However, data on long-term TTR after renal denervation (RDN) and its association with neuroendocrine parameters in patients with resistant hypertension (RHTN) are lacking.

Aim: To assess the association between SBP time in the target range after RDN, based on over 3 years of follow-up, and the neurohormonal profile indicators in patients with RHTN.

Material and Methods. Data from 89 patients with RHTN who completed ≥ 3 years of follow-up after RDN (median 5 years, range 3–9 years) from studies NCT01499810 and NCT02667912 were analyzed. Standard examination, including 24-hour ambulatory blood pressure (BP) monitoring, was performed. A biomarker panel of neurohormonal parameters (renin, angiotensin II, aldosterone, NT-proBNP, BNP, metanephrines and normetanephrines) was studied by ELISA; erythrocyte membrane beta-adrenoreactivity (β-AR) was measured using the β-AR-AGAT kit.

Results. After RDN, a significant reduction in clinical and 24-hour BP was observed (p < 0.01 for both). Mean TTR reached 29%. The frequency of TTR < 25% was 46%; 25–49% – 26%; ≥ 50% – 28%. Patients with TTR ≥ 50% had not only initially higher levels of metanephrines, normetanephrines and natriuretic peptides (p < 0.05), but also a significant reduction in these markers after RDN, more pronounced than in other groups (p < 0.05). The TTR ≥ 50% group also had higher baseline aldosterone levels (p = 0.022) and lower β-AR values (p = 0.12), with a more pronounced increase in β-AR (p = 0.03) and a decrease in 24-hour SBP variability (p = 0.02) after RDN. In patients with a decrease in catecholamines after RDN compared to those with an increase, mean TTR was 7 times higher (50% vs. 7.14%, respectively, p = 0.016).

Conclusion. The association between the duration systolic blood pressure (SBP) time in target range after renal denervation and the baseline state of sympathoadrenal activity in patients with resistant hypertension suggests that correction of the neurohormonal profile may be one of the key mechanisms of the therapeutic action of this intervention.

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