Organ damage changes in patients with resistant hypertension randomized to renal denervation or spironolactone: The DENERVHTA (Denervación en Hipertensión Arterial) study

Abstract

Renal denervation and spironolactone have both been proposed for the treatment of resistant hypertension, but their effects on preclinical target organ damage have not been compared. Twenty-four patients with 24-hour systolic blood pressure ≥140 mm Hg despite receiving three or more full-dose antihypertensive drugs, one a diuretic, were randomized to receive spironolactone or renal denervation. Changes in 24-hour blood pressure, urine albumin excretion, arterial stiffness, carotid intima-media thickness, and left ventricular mass index were evaluated at 6 months. Mean baseline-adjusted difference between the two groups (spironolactone vs renal denervation) at 6 months in 24-hour systolic blood pressure was -17.9 mm Hg (95% confidence interval [CI], -30.9 to -4.9; P = .01). Mean baseline-adjusted change in urine albumin excretion was -87.2 (95% CI, -164.5 to -9.9) and -23.8 (95% CI, -104.5 to 56.9), respectively (P = .028). Mean baseline-adjusted variation of 24-hour pulse pressure was -13.5 (95% CI, -18.8 to -8.2) and -2.1 (95% CI, -7.9 to 3.7), respectively (P = .006). The correlation of change in 24-hour systolic blood pressure with change in log-transformed urine albumin excretion was r = .713 (P < .001). At 6 months there was a reduction in albuminuria in patients with resistant hypertension treated with spironolactone as compared with renal denervation.

Trial registration: ClinicalTrials.gov NCT02039492.

Keywords: albuminuria; arterial stiffness; carotid wall thickness; end organ damage; left ventricular hypertrophy; renal denervation; spironolactone.

Conflict of interest statement

The corresponding author (AO) contributes to scientific advisory with Medtronic Ibérica, SA. The remaining authors have no conflicts of interest to disclose.

©2018 Wiley Periodicals, Inc.

Figures

Figure 1

Individual changes in albuminuria from baseline to 6 months in the (A) renal denervation group and the (B) spironolactone group. Log‐UAE indicates log‐transformed urine albumin excretion

Figure 2

Correlation between changes in 24‐hour systolic blood pressure (SBP) and urine albumin excretion (UAE) at 6 months