Objective:
To compare the effect of renal denervation (RDN) and spironolactone, two proposed therapeutic strategies for the treatment of patients with resistant hypertension (RH), on preclinical target organ damage (pTOD).
Methods:
Patients with office systolic blood pressure (SBP) ≥150 mmHg and 24h-SBP ≥140 mmHg despite receiving ≥3 full-dose antihypertensive drugs, one a diuretic, but none aldosterone antagonist, were randomized to receive RDN or spironolactone (50mg), as add-on therapy. Changes (Δ) in 24h-BP, as well as Δ in urinary albumin excretion (ΔUAE), carotid-femoral pulse-wave velocity (ΔcfPWV), carotid intima-media thickness (ΔIMT), left ventricular mass index (ΔLVMI) and E/e’ (ΔE/e’), a marker of hypertension-induced diastolic dysfunction, were evaluated at 6 months. Between-group comparisons of ΔUAE (after log transformation), ΔcfPWV, ΔIMT, ΔLVMI and ΔE/e’ were carried out by generalized linear models before and after adjusting by Δ24h-SBP and the corresponding baseline value.
Results:
Twenty-four patients (mean age 64±8 yr) were included. Mean baseline-adjusted difference (95% CI) between the two groups (Spironolactone vs.RDN) at 6 months in 24h-SBP (mmHg) was of-17.9 (-30.9 to -4.9), p=0.01. As shown in the table, there were no statistically significant between-group differences in Δ on pTOD.
Conclusion:
Changes at 6 months on pTOD as assessed by UAE, cfPWV, IMT, LVMI and E/e’, were not associated with the therapeutic add-on strategy used to reduce high blood pressure in RH patients. We cannot discard that the high variability of some of these markers, especially UAE, could account for this lack of statistically significant between-group differences.
Correlations of Circadian Rhythm Disorder of Blood Pressure with Arrhythmia and Target Organ Damage in Hypertensive Patients