Clinical Effect of Renal Denervation on Resistant Hypertension in Obese and Nonobese Patients: Insights from Kuwait.

Abstract

Background: Renal denervation (RDN) has demonstrated blood pressure (BP) - lowering efficacy in resistant hypertension; however, response heterogeneity remains incompletely understood. Obesity is associated with sympathetic overactivity and may influence the BP response to RDN. We evaluated BP changes following Symplicity Spyral RDN in a real-world cohort stratified by obesity status.

Methods: We conducted a retrospective single-center cohort study including patients with resistant hypertension who underwent radiofrequency RDN using the Symplicity Spyral system at Sabah Al-Ahmad Cardiac Center in Kuwait between March 2023 and August 2024. BP was assessed at baseline, immediate postprocedure, and at 6 months. The primary outcome was change in systolic and diastolic BP at 6 months and the comparison between obese and nonobese patients. Secondary outcomes included time to achieving BP targets and clinical predictors of target achievement.

Results: A total of 50 patients underwent RDN (mean age: 61.7 years); 32 were obese, and 18 were nonobese. In the overall cohort, systolic BP (SBP) decreased from 163.7 ± 24.6 mmHg at baseline to 129.4 ± 13.5 mmHg at 6 months (P < 0.001), and diastolic BP decreased from 86.7 ± 16.6 mmHg to 75.9 ± 8.2 mmHg (P = 0.0004). Repeated measures analysis of covariance demonstrated significant SBP changes over time (P < 0.001) with no overall between-group difference by obesity status; however, a significant time × body mass index category interaction was observed for SBP (P = 0.038). Kaplan-Meier analysis showed a median time of 2 months to BP target achievement in both the groups. In multivariable logistic regression, dyslipidemia was independently associated with lower odds of BP target achievement (odds ratio: 0.17, 95% confidence interval: 0.03-0.80;P= 0.036).

Conclusion: In this real-world cohort, Symplicity Spyral RDN was associated with significant BP reduction at 6 months in both obese and nonobese patients. Obesity status did not appear to diminish overall BP-lowering efficacy, although SBP response trajectory differed over time. In exploratory multivariable analysis, dyslipidemia was associated with lower odds of BP target achievement.