Sex stratified analysis of patients with resistant hypertension from the Global SYMPLICITY Registry of renal denervation

Our aim was a sex-specific analysis to characterize the phenotype for women with resistant hypertension (rHTN), an understudied population, referred for renal denervation (RDN) from the Global SYMPLICITY Registry DEFINE (N = 3332 patients). For this analysis, 2502 patients with uncontrolled hypertension (office systolic blood pressure (SBP) ≥140 mmHg, ≥3 antihypertensive drugs) were referred for RDN. Age at baseline was 18-88 years for men and 21-89 years for women. We used propensity score matching to account for demographic differences at baseline identified by multivariate regression analysis. Changes in BP, outcomes (all-cause death, cardiac death, stroke, myocardial infarction), and quality of life (QoL) after 36 months were assessed. Women had fewer comorbidities at baseline but had higher BP and worse QoL, anxiety, and depression compared to men. After propensity matching to minimize bias, BP changes were comparable by sex, and BP was significantly reduced from baseline following RDN. Women ≥55 years of age with resistant hypertension had a greater reduction in BP compared with women <55 years. At 36 months after RDN, there was a significant 12% reduction in anxiety/depression compared to baseline for women with resistant hypertension. When baseline office SBP was in the highest tertile (>178 mmHg), cardiac death was more prevalent in women (6.1%) than men (1.7%). Our sex-stratified analysis of the global registry allowed a longitudinal assessment, providing important insights into the phenotype of resistant hypertension in women. We identified sex-specific differences that highlight the need for early detection and management of hypertension in women.