Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Phenotypes of Treatment Resistant Hypertension and their Response to Interventional Renal Denervation
K. Fengler1, K.-P. Kresoja1, K.-P. Rommel1, S. Blazek1, S. Rosch1, C. Lücke2, M. Gutberlet2, H. Thiele1, P. Lurz1
1Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 2Diagnostische und Interventionelle Radiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig;

Background: A relevant part of patients with arterial hypertension are uncontrolled, despite optimal medical treatment. While there is a consensus on general treatment for these patients, the role of the pathogenesis and the different hemodynamic components behind uncontrolled arterial hypertension is ill-defined. We aimed to describe different phenotypes of arterial hypertension in a cohort of treatment resistant hypertension undergoing renal denervation (RDN).

Methods: Patients underwent assessment of aortic distensibility and stroke volume using cardiac magnetic resonance imaging and non-invasive assessment of pulse wave forms prior to RDN. Patients were then classified to either one of four different phenotypes: 1) Excessive arterial stiffness (EAS), 2) stroke volume / aortic diameter mismatch (SVAMM), 3) excessive wave reflection (EWR) or 4) mixed. Patients were compared regarding clinical baseline characteristics as well as ambulatory blood pressure (ABPM) change 3 months after RDN.

Results: 65 patients were available for analysis and 3 months ABPM values were available in 64 patients. Patients in the SVAMM group had higher body mass index (35±6 vs. 30±6 [EWR], 29±6 [EAS] and 31±4 [mixed] respectively, p = 0.023) and were prescribed more antihypertensive drug classes (5.9±1.5 vs. 4.4±1.7 [EWR], 4.4±1.5 [EAS] and 5.4±2.0 [mixed] respectively, p = 0.021) than the other 3 groups. After 3 months, patients with the EWR and SVAMM phenotype had the strongest reduction in systolic and diastolic ABPM when compared to patients with EAS or a mixed phenotype (-15/8±15/8 mmHg [EWR] and -13/10±8/8 mmHg [SVAMM] vs. -3/1±10/7 mmHg [EAS] and -6/5±10/8 mmHg [mixed] respectively, p = 0.012/0.010).

Conclusions: Phenotyping of patients with resistant hypertension can help to identify potential reversible contributors to elevated blood pressure and preselect patients with good response to RDN. Phenotyping could be used to establish individualized, patient tailored antihypertensive treatment plans for patients suffering from arterial hypertension. Such an approach should be studied in future trials.


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