To compare the effect on circadian blood pressure (BP) and BP variability of treatment with sympathetic renal denervation versus spironolactone in resistant hypertensive patients.Design and Method:
The DENERVHTA study was a randomized, open trial in 23 resistant hypertensive patients (office systolic BP > 150 and 24-hour systolic BP > 140, while on treatment with at least 3 antihypertensive drugs, one of them a diuretic). Good compliance with antihypertensive medication and eligibility of renal arteries anatomy was ensured before randomization. Patients were randomized 1:1 to renal denervation or spironolactone 50 mg. The primary outcome was changes in 24-hour systolic BP. The present analysis compares both treatments on daytime and nighttime BP, night-to-day ratio and measures of BP variability, including standard deviation, weighted standard deviation, coefficient of variation and average real variability.Results:
Sprinolactone was superior to renal denervation in reducing 24-hour systolic BP (primary outcome). Spironolactone was also superior in reducing daytime systolic and diastolic BP, whereas differences in nighttime BP or in the night-to-day ratios did not reach statistical significance. Without differences in the effect on systolic BP variability, renal denervation was superior to spironolactone in reducing diastolic variability (before and after adjusting for BP differences). Significant differences were observed in 24-hour, daytime and nighttime SD and CV, as well as in weighted SD and average real variability.Conclusions:
Spironolactone is superior to renal denervation in reducing BP in resistant hypertensive patients. However, renal denervation reduces BP variability in comparison to spironolactone. This reduction in BP variability could be of importance in preventing cardiovascular events in patients treated with such technique.