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Effect of renal denervation in attenuating the stress of morning surge in blood pressure: post-hoc analysis from the SPYRAL HTN-ON MED trial

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Abstract

Background

Catheter-based renal denervation (RDN) reduces blood pressure (BP) throughout the 24-h period, as reported in several randomized sham-controlled trials. Reduction of BP in the early morning hours is especially important due to increased cardiovascular risks during that time.

Objective

In this report, we examine the impact of RDN on systolic BP (SBP) and diastolic BP (DBP) during the critical morning surge period in a post-hoc analysis of patients in the SPYRAL HTN-ON MED trial.

Methods and results

Ambulatory BP measurements were collected at baseline and 6 months for treatment and control patient groups over 24-h periods. Average morning BP surge is the difference between average morning BP and average nighttime BP, and the morning surge slope reflects the rate of change of BP from nighttime to morning. Mean morning DBP surge slopes were significantly lower for RDN vs. control groups at 6 months (1.1 vs. 3.6 mmHg/h; p = 0.029). In the RDN group, morning DBP surge slopes were significantly lower at 6 months compared to baseline (1.1 vs. 4.1 mmHg/h; p = 0.006). Similar patterns were observed for mean morning SBP surge slope but did not reach statistical significance.

Conclusions

This decrease in the morning DBP surge slope, an index of the sympathetically-mediated morning BP surge, thus indicates a drop in late morning BP relative to early morning/nocturnal BP in the RDN group. Thus, RDN appears effective in attenuating the slope of morning surge in DBP that might indicate possible benefits in a high-risk hypertensive population.

Clinical trial registration

https://www.clinicaltrials.gov (NCT02439775), registered May 12, 2015.

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Acknowledgements

Beth Ferri, PhD, CMPP provided editorial support, and Sandeep Brar, MD, Daiki Yasuhara, and Manuela Negoita, MD provided excellent study management, all of Medtronic.

Funding

Medtronic PLC, Santa Rosa, CA, USA.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Kazuomi Kario

  2. Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, NY, USA

    Michael A. Weber

  3. Department of Internal Medicine, Klinik für Innere Medizin III, Universitätsklinikum Des Saarlandes, Saarland University, Homburg/Saar, Germany

    Michael Böhm & Felix Mahfoud

  4. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Raymond R. Townsend & Sidney A. Cohen

  5. Department of Nephrology and Hypertension, Universitätsklinikum Erlangen, Erlangen, Germany

    Roland E. Schmieder

  6. Department of Cardiology, National and Kapodistrian University of Athens, Hippocratio Hospital, Athens, Greece

    Konstantinos Tsioufis

  7. Coronary and Structural Heart, Medtronic PLC, Santa Rosa, CA, USA

    Sidney A. Cohen & Martin Fahy

  8. Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA, USA

    David E. Kandzari

Authors
  1. Kazuomi Kario
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  2. Michael A. Weber
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  3. Michael Böhm
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  4. Raymond R. Townsend
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  7. Konstantinos Tsioufis
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  8. Sidney A. Cohen
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  10. David E. Kandzari
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Corresponding author

Correspondence to Kazuomi Kario.

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Conflict of interest

Prof Kario has received honoraria for lectures from Medtronic, Otsuka, and Daichisankyo, ReCor, and research fund/Grant from Omron Healthcare, A&D, and Fukuda Denshi. Dr. Weber has received consulting fees from Medtronic, ReCor, Ablative Solutions, Abbvie, Johnson &Johnson, Bristol-Myers Squibb, Conjupro, Regeneron and Urovent. Prof Böhm reports support from Abbott, Astra-Zeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Medtronic, Novartis, ReCor, Servier, Vifor, and by the Deutsche Forschungsgemeinschaft (DFG, TTR 219, S-01, M-03, M-05). Dr. Townsend is a consultant to Medtronic and receives royalties from UpToDate. Prof Mahfoud has received speaker honoraria from Medtronic and Recor, and is supported by Deutsche Hochdruckliga, Deutsche Gesellschaft für Kardiologie and Deutsche Forschungsgemeinschaft. Prof Schmieder has received speaker and consulting honoraria from Medtronic, ReCor, Ablative Solutions, and Rox Medical. Prof Tsioufis has received honoraria for advisory boards and lectures from Medtronic, Servier, Bayer, Menarini, Novartis, Astra-Zeneca, Boehringer In, Pfizer, Pythagoras, Sanofi, and Amgen. Dr. Cohen and Mr. Fahy are employees and shareholders of Medtronic. Dr. Kandzari has received research/Grant support from Medtronic and Ablative Solutions, and consulting honoraria from Medtronic.

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Kario, K., Weber, M.A., Böhm, M. et al. Effect of renal denervation in attenuating the stress of morning surge in blood pressure: post-hoc analysis from the SPYRAL HTN-ON MED trial. Clin Res Cardiol 110, 725–731 (2021). https://doi.org/10.1007/s00392-020-01718-6

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  • DOI: https://doi.org/10.1007/s00392-020-01718-6

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