BACKGROUND: Sympathetic tone is one of the main determinants of blood pressure (BP) variability and treatment-resistant hypertension. The aim of our study was to assess changes in BP variability after renal denervation (RDN). In addition, on an exploratory basis, we investigated whether baseline BP variability predicted the BP changes after RDN. METHODS: We analyzed 24-h BP recordings obtained at baseline and 6 months after RDN in 167 treatment-resistant hypertension patients (40% women; age, 56.7 years; mean 24-h BP, 152/90 mmHg) recruited at 11 expert centers. BP variability was assessed by weighted SD [SD over time weighted for the time interval between consecutive readings (SDiw)], average real variability (ARV), coefficient of variation, and variability independent of the mean (VIM). RESULTS: Mean office and 24-h BP fell by 15.4/6.6 and 5.5/3.7 mmHg, respectively (P < 0.001). In multivariable-adjusted analyses, systolic/diastolic SDiw and VIM for 24-h SBP/DBP decreased by 1.18/0.63 mmHg (P ≤ 0.01) and 0.86/0.42 mmHg (P ≤ 0.05), respectively, whereas no significant changes in ARV or coefficient of variation occurred. Furthermore, baseline SDiw (P = 0.0006), ARV (P = 0.01), and VIM (P = 0.04) predicted the decrease in 24-h DBP but not 24-h SBP after RDN. CONCLUSION: RDN was associated with a decrease in BP variability independent of the BP level, suggesting that responders may derive benefits from the reduction in BP variability as well. Furthermore, baseline DBP variability estimates significantly correlated with mean DBP decrease after RDN. If confirmed in younger patients with less arterial damage, in the absence of the confounding effect of drugs and drug adherence, baseline BP variability may prove a good predictor of BP response to RDN.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Krakow Poland

3rd Department of Internal Medicine General University Hospital and 1st Faculty of Medicine Charles University Prague

Abdominal Center Nephrology University of Helsinki and Helsinki University Central Hospital

BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK

Cardiocentre University Hospital Královské Vinohrady and 3rd Faculty of Medicine Charles University Prague Czech Republic

Cardiovascular Diseases Research Group UiT The Arctic University of Norway Norway

Cliniques Universitaires Saint Luc Université Catholique de Louvain Brussels Belgium

Department of Cardiology and Department of Acute Medicine Oslo University Hospital University of Oslo Oslo Norway

Department of Cardiology Isala Klinieken Zwolle The Netherlands

Department of Cardiology University Hospital of North Norway Tromsø

Department of Medical Sciences Internal Medicine and Hypertension Division AOU Città della Salute e della Scienza Turin Italy

Department of Nephrology University Medical Center Utrecht Utrecht The Netherlands

Department of Vascular Medicine University Medical Center Utrecht Utrecht The Netherlands

Folkhälsan Institute of Genetics Folkhälsan Research Center Helsinki Finland

Julius Center for Health Sciences and Primary Care University Medical Center Utrecht

Karolinska Institute Department of Clinical Sciences Danderyd Hospital Division of Cardiovascular Medicine Stockholm Sweden

Minerva Institute for Medical Research Helsinki Finland

Pole of Cardiovascular Research Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain

R and D Group VitaK Maastricht University Maastricht The Netherlands

Service of Nephrology Lausanne University Hospital Lausanne Switzerland

Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Leuven Belgium

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