# Two-year nighttime blood pressure changes after radiofrequency renal denervation: pooled results from the SPYRAL HTN trials

## TL;DR

This study shows that radiofrequency renal denervation significantly lowers nighttime blood pressure over two years in patients with hypertension, including those with abnormal blood pressure patterns.

## Contribution

The study demonstrates the long-term effectiveness of RF RDN in reducing nighttime BP across different dipping patterns and comorbidities.

## Key findings

- RF RDN significantly reduced nighttime systolic blood pressure by 12 mmHg over two years.
- Patients with riser patterns had the highest baseline nighttime BP and the greatest reduction after RDN.
- RDN was equally effective in older patients and those with comorbidities like diabetes and sleep apnea.

## Abstract

Elevated nighttime blood pressure (BP) and abnormal circadian dipping patterns are associated with advanced age and coexisting illnesses and are attributed to autonomic dysfunction. Radiofrequency renal denervation (RF RDN) effectively lowers BP throughout 24 h and thus may provide an effective antihypertensive therapeutic option. This analysis assesses the effects of RDN on nocturnal hypertension with different dipper patterns defined by nighttime/daytime BP ratio (i.e. dippers, non-dippers, risers) through 2 years in patients randomized to RDN from the SPYRAL HTN-OFF MED and -ON MED trials. Office and 24-h ambulatory BP, were also evaluated in patients stratified by age, obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Among 388 patients, the baseline nighttime systolic BP (SBP) was 139.3 ± 11.3 mmHg. Patients with a riser pattern had the highest baseline nighttime SBP (152.7 ± 8.0 mmHg). At 2 years, patients experienced a significant reduction from baseline (p < 0.0001) in nighttime (−12.0 ± 17.1 mmHg), morning (−14.8 ± 20.0 mmHg), daytime (−13.8 ± 14.7 mmHg), and 24-h SBP (−13.4 ± 14.2 mmHg). The greatest reduction in SBP was in risers at nighttime (−23.7 ± 14.3 mmHg). RDN was equally effective in lowering nighttime BP in patients ≥65 years old or with OSA, CKD, or T2DM. In this pooled dataset of RF RDN patients, clinically meaningful reductions in BP over a 24-h period were observed through 2 years irrespective of dipping status. RF RDN may reduce the risk of cardiovascular outcomes in patients with uncontrolled hypertension, especially in those with elevated nighttime BP who may be the most challenging to treat.