Abstract 4369322: Sex-Based Differences in Systolic Blood Pressure Response After Renal Denervation: A Meta-Analysis

Introduction/Background: Renal denervation (RDN) is an emerging interventional endovascular procedure for the management of resistant hypertension. While its efficacy is well established, the influence of sex on treatment response remains unclear. RND requires a highly skilled interventionalist, is expensive and invasive, making this research question essential to better tailor RDN recommendation in the management of resistant hypertension. Research Questions/Hypothesis: We aim to determine whether males and females experience any difference in systolic blood pressure (SBP) reduction Post-RDN. We hypothesized that men would experience a greater reduction in Systolic Blood Pressure (SBP) Post-RDN due to their higher baseline sympathetic tone. Methods/Approach: We conducted a fixed-effects meta-analysis of five studies reporting sex-stratified SBP outcomes in Post-RDN patients: SYMPLICITY HTN-3, SPYRAL HTN-OFF MED, RADIANCE-HTN TRIO, RADIANCE-HTN SOLO, and Zyubanova et al. The primary outcome we determined was the mean difference in SBP reduction (ΔSBP = Male – Female). Standard errors were derived from reported or estimated standard deviations. A leave-one-out sensitivity analysis was performed to assess the influence of individual studies on the pooled estimate. Results/Data: The pooled analysis included 1,238 patients (692 males, 546 females) with the overall pooled mean difference (MD) in systolic blood pressure (SBP) reduction favoring males with -1.59 mmHg reduction (95% CI: –3.27 to +0.09). Randomized controlled trials (RCTs), including SYMPLICITY HTN-3 and SPYRAL, demonstrated consistent trends favoring males, with a pooled MD of –2.3 mmHg. However, one observational study (Zyubanova et al.) reported a reverse effect, favoring females (+13.4 mmHg). A leave-one-out sensitivity analysis excluding the Zyubanova study yielded a statistically significant male-favoring effect with MD –2.30 mmHg (95% CI: –4.02 to –0.58). These findings highlight the potential influence of study design on observed sex-based differences in SBP response. Conclusion(s): In the pooled analysis, there was no significant difference in SBP reduction based on sex, but once the observational cohort was removed, males showed a significant difference in lowering SBP. These findings are in concurrence with the sympathetic tone difference between the sex and urge the need for consistent sex-stratified reporting in future RDN trials to support individualized RDN therapy.