Abstract 4357557: Renal Denervation versus Baroreflex Activation Therapy in Resistant Hypertension: Outcomes from a Real-World Registry

Background: Device-based therapies for hypertension, including renal denervation and baroreflex activation therapy, offer alternative strategies for blood-pressure control. Methods: We conducted a retrospective cohort study using TriNetX to compare adults (≥18 y) with resistant hypertension who underwent renal denervation (RDV) or baroreflex activation therapy (BAT) through October 2024, assessing efficacy and safety at 4, 8, 12, and 26 weeks post-procedure after propensity score matching. Results: After propensity-score matching (215 patients per arm), patients were followed for 4, 8, 12, and 26 weeks. At week 4, RDV achieved blood-pressure targets less often than BAT—RRs: 0.612 for SBP ≤ 130 mm Hg, 0.664 for DBP ≤ 80 mm Hg, 0.690 for SBP ≤ 130 or DBP ≤ 80, 0.674 for SBP ≤ 140, 0.772 for DBP ≤ 90, and 0.788 for SBP ≤ 140 or DBP ≤ 90 (all p < 0.005)—but had lower rates of AKI (0.420, p = 0.012), serious adverse events (SAEs) (0.289, p < 0.001), and hypotension (0.480, p < 0.001), with no differences in hospitalization, MACE, mortality, electrolyte disturbances, peripheral edema, headache, or dizziness. This trend persisted at week 8, with BP-target RR 0.615–0.775 (p ≤ 0.001) and continued reductions in AKI (0.323, p = 0.001), SAEs (0.342, p < 0.001), and hypotension (0.462, p < 0.001), while peri-procedural complications trended lower (0.571, p = 0.103) and other safety outcomes remained unchanged. At week 12, RDV again showed lower BP control (RR 0.636–0.805, p ≤ 0.002) with sustained reductions in AKI (0.278), hypotension (0.521), and SAEs (0.399) (all p < 0.001), and no change in hospitalization, MACE, mortality, biochemical abnormalities, peripheral edema, headache, or dizziness. By week 26, RDV continued to underperform in BP control—RR 0.69 for SBP ≤ 130 mm Hg, 0.66 for DBP ≤ 80 mm Hg, 0.73 for SBP ≤ 130 or DBP ≤ 80 mm Hg, 0.73 for SBP ≤ 140 mm Hg (all p < 0.001), and 0.83 for DBP ≤ 90 mm Hg or SBP ≤ 140/DBP ≤ 90 mm Hg (p = 0.005)—but maintained fewer SAEs (0.45, p < 0.001) and hyperkalemia (0.39, p = 0.005), with no differences in MACE, mortality, hospitalization, AKI, other electrolyte disturbances, or peripheral edema, headache, or dizziness. Conclusion: BAT achieved superior and sustained blood-pressure reductions relative to RDV, whereas RDV consistently conferred a more favorable safety profile, with significantly fewer AKI episodes, serious adverse events, and hypotension through 26 weeks.