Journal of the American College of Cardiology | 2021
Changes in Plasma Renin Activity after Renal Artery Sympathetic Denervation.
Abstract
BACKGROUND\nThe renin-angiotensin-aldosterone system plays a key role in blood pressure (BP) regulation and is the target of several anti-hypertensive medications. Renal denervation (RDN) is thought to interrupt the sympathetic-mediated neurohormonal pathway as part of its mechanism of action to reduce BP.\n\n\nOBJECTIVES\nTo evaluate plasma renin activity (PRA) and aldosterone before and after RDN and to assess whether these baseline neuroendocrine markers predict response to RDN.\n\n\nMETHODS\nAnalyses were conducted in patients with confirmed absence of antihypertensive medication. Aldosterone and PRA levels were compared at baseline and 3 months post-procedure for RDN and sham control groups. Patients in the SPYRAL HTN-OFF MED Pivotal trial were separated into 2 groups, those with baseline PRA ≥0.65 (N=110) vs. <0.65 ng/mL/hour (N=116). Follow-up treatment differences between RDN and sham control groups were adjusted for baseline values using multivariable linear regression models.\n\n\nRESULTS\nBaseline PRA was similar between RDN and control groups (1.0±1.1 vs. 1.1±1.1 mg/mL/hour, p=0.37). Change in PRA at 3 months from baseline was significantly greater for RDN compared with control (-0.2±1.0, p=0.019 vs. 0.1±0.9 mg/mL/hour, p=0.14), p=0.001 for RDN vs. control, and similar differences were seen for aldosterone: RDN compared with control (-1.2±6.4, p=0.04 vs. 0.4±5.4 ng/dL, p=0.40), p=0.011. Treatment differences at 3 months in 24-hour and office systolic BP (SBP) for RDN vs. control patients were significantly greater for patients with baseline PRA ≥0.65 vs. <0.65 ng/mL/hour, despite similar baseline BP. Differences in office SBP changes according to baseline PRA were also observed earlier at 2 weeks post-RDN.\n\n\nCONCLUSIONS\nPlasma renin activity and aldosterone levels for RDN patients were significantly reduced at 3 months when compared with baseline as well as when compared with sham control. Higher baseline PRA levels were associated with a significantly greater reduction in office and 24-hour SBP.