Discussion
stroke, BP reduction
STROKE, HEART FAILURE, HTN, EVENTS
This is the first report to show significant and persistent nighttime and morning BP reduction following radiofrequency RDN compared to a sham control group at 3 years. These outcomes were consistent irrespective of the number of medications that were prescribed, including high risk patients on 3 or more antihypertensive medications. Whereas control group patients had somewhat variable long-term BP reductions over 24 h, presumably due to increased drug usage guided by office BP, RDN group patients had more consistent BP reductions across the night and morning periods. This indicates that long term up-titration of medication reduced office and daytime BPs, but it’s BP lowering effect appears insufficient to achieve nighttime and morning BP control. However, RDN significantly and persistently reduced 24 h BPs including nighttime and morning BP, providing more uniform BP control over a 24 h period.Ambulatory blood pressure, particularly nighttime and morning surge blood pressure predict cardiovascular outcomes including heart failure, stroke, and mortality better than clinic blood pressure [The definition for morning blood pressure applied in the present analysis was restricted (6:00–8:59 AM) since early morning SBP is the strongest predictor of cardiovascular events [The magnitude of BP reduction following RDN may be more apparent at nighttime or in the early morning hours. Notably, the between-group SBP changes were numerically lower for daytime but not nighttime SBP in the SPYRAL HTN OFF MED pivotal trial [The present results supporting RDN efficacy to at least 3 years of follow-up confirm and extend recent pre-clinical [The present analysis has limitations. Non-adherence to prescribed antihypertensive drug therapy was objectively assessed at discrete timepoints but adherence over an extended period is uncertain. BP control worsened in the US during the COVID-19 pandemic which may have impacted BP results [In summary, morning and nighttime SBP were significantly reduced in patients prescribed at least 3 antihypertensive medications at 36 months in the SPYRAL HTN-ON MED trial after RDN compared to sham control. The results during these times of high sympathetic tone suggest that radiofrequency RDN has significant long-term benefit when the plasma levels of drug concentrations are the lowest and the risk of cardiovascular events is highest.