Background:Renal denervation (RDN) lowers blood pressure (BP), but BP response is variable in individual patients. We investigated whether measures of pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, predict BP drop following RDN.Methods:From the randomized, sham-controlled SPYRAL HTN-OFF MED Pivotal trial, we performed a post hoc analysis of BP waveforms from 111 RDN patients and 111 sham controls, obtained with a brachial cuff-based sphygmomanometer. Waveforms were acquired during ambulatory BP monitoring at diastolic BP level and processed with validated ARCSolver algorithms to derive hemodynamic parameters (augmentation index; augmentation pressure; backward and forward wave amplitude; estimated aortic pulse wave velocity). We investigated the relationship between averaged 24-hour values at baseline and the change in 24-hour BP at 3 months in RDN patients, corrected for observed trends in the sham group.Results:There was a consistent inverse relationship between baseline augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity and BP response to RDN: the decrease in 24-hour systolic BP/diastolic BP was 7.8/5.9 (augmentation index), 8.0/6.3 (augmentation pressure), 6.7/5.4 (backward wave amplitude), 5.7/4.7 (forward wave amplitude), and 7.8/5.2 (estimated aortic pulse wave velocity) mm Hg greater for patients below versus above the respective median value (P<0.001 for all comparisons, respectively). Taking augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity into account, a favorable BP response following RDN, defined as a drop in 24-hour systolic blood pressure of ≥5 mm Hg, could be predicted with an area under the curve of 0.70/0.74/0.70/0.65/0.62 (P<0.001 for all, respectively).Conclusions:These results suggest that pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, may predict BP response to RDN.

中文翻译：

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在 SPYRAL HTN-OFF MED 试验中，24 小时脉动血流动力学预测肱动脉血压对去肾神经支配的反应

背景：去肾神经支配 (RDN) 可降低血压 (BP)，但个体患者的 BP 反应各不相同。我们调查了在 24 小时动态血压监测期间获得的脉动血流动力学测量是否可以预测 RDN 后的血压下降。方法：从随机、假对照的 SPYRAL HTN-OFF MED Pivotal 试验中，我们对来自的 BP 波形进行了事后分析。 111 名 RDN 患者和 111 名假对照组，使用基于臂带的血压计获得。在舒张压水平的动态血压监测期间采集波形，并使用经过验证的 ARCSolver 算法进行处理，以得出血流动力学参数（增强指数；增强压力；后向和前向波幅度；估计的主动脉脉搏波速度）。所有比较的P <0.001，分别）。考虑到增强指数/增强压力/后向波幅度/前向波幅度/估计的主动脉脉搏波速度，可以预测 RDN 后有利的 BP 反应，定义为 24 小时收缩压下降≥5 mm Hg曲线下面积为 0.70/0.74/0.70/0.65/0.62（分别为P <0.001）。结论：这些结果表明，在 24 小时动态血压监测期间获得的脉动血流动力学可以预测 BP 对 RDN 的反应.