Association between arterial stiffness and long-term efficacy of renal sympathetic denervation: 5-year results of the ASORAS study

The objective was to assess the effect of preprocedural arterial stiffness on long-term blood pressure (BP) reduction following renal sympathetic denervation (RDN). In this prospective, single-arm pilot study, patients with systolic office BP ≥ 140 mmHg and mean 24-h systolic ambulatory blood pressure (ABP) ≥ 130 mmHg despite being on a minimum of 3 antihypertensive drugs underwent radiofrequency RDN. The primary efficacy outcome was the temporal evolution of mean 24-h systolic ABP throughout 5 years post RDN. Effect modification of the primary outcome was studied for baseline magnetic resonance pulse wave velocity (MR-PWV), MR aortic distensibility (MR-AoD), ultrasound carotid femoral pulse wave velocity (CF-PWV) and clinical parameters. Analyses were performed using linear mixed-effects models to account for repeated BP measurements. A total of 30 patients were enrolled, 50% were female, mean age was 62.5 ± 10.7 years. Baseline mean 24-h ABP was 146.7/80.8 ± 13.7/12.0 despite a median of 5.0 ± 2.4 defined daily doses (DDD) of antihypertensive drugs. Baseline median MR-PWV was 6.8 [25th-75th percentile: 6.1-11.0] m/s, median MR-AoD was 1.4 × 10^-3 mmHg^-1 [25th-75th percentile: 0.9-1.8] and mean CF-PWV was 8.5 ± 2.1 m/s. Throughout 5 years following RDN, the change in mean 24-h systolic ABP was - 11.5 [95% CI - 17.0, - 5.9] mmHg (p = <0.001). MR-PWV emerged as the sole significant independent effect modifier of the change in mean 24-h systolic ABP throughout 5 years following RDN (+ 1.8 [95% CI 0.7, 2.8] mmHg per m/s per 5 years; p = 0.001). A higher level of preprocedural arterial stiffness, as measured using MR-PWV, was associated with a smaller BP lowering effect 5 years post-RDN.