Effect of catheter-based renal denervation on orthostatic blood pressure adaptation in patients with uncontrolled hypertension.

BACKGROUND

This study aimed to evaluate the effect of catheter-based renal denervation (RDN) on orthostatic blood pressure (BP) adaptation in patients with uncontrolled hypertension.

METHODS

This prospective observational study enrolled patients who had been previously included in the multicenter Iberis-HTN trial and Netrod™-HTN trial. Eligible patients were randomly assigned to undergo either radiofrequency RDN or a sham procedure. BP and heart rate (HR) changes during a 3-min orthostatic challenge from supine to standing were measured at baseline and 6 months after randomization.

RESULTS

At 6 months, the RDN group exhibited a significantly greater reduction in ambulatory BP, office systolic blood pressure (SBP) and BP in both supine and standing positions compared to the sham group. After adjusting for baseline values, the magnitude of changes in orthostatic SBP and diastolic blood pressure (DBP) at the 3-min timepoint, along with the maximum changes observed throughout the 3-min orthostatic test, was significantly smaller in the RDN group at 6 months (3 min: SBP/DBP, p = 0.008/0.010; Maximum: SBP/DBP, p = 0.041/0.004). The changes in orthostatic HR at 6 months were comparable between the RDN and the sham group.

CONCLUSIONS

Catheter-based radiofrequency RDN significantly reduced BP in both supine and standing positions during active standing at 6 months compared to the sham group. Additionally, RDN attenuated BP elevation during postural changes, and the response pattern to orthostatic stress was partially restored toward the range of normal physiological variation. This observation may be related to the reduction in excessive vascular tone in response to orthostatic stress after RDN.