Changes in Plasma Renin Activity after Renal Artery Sympathetic Denervation.

Abstract Background The renin-angiotensin-aldosterone system plays a key role in blood pressure (BP) regulation and is the target of several anti-hypertensive medications. Renal denervation (RDN) is thought to interrupt the sympathetic-mediated neurohormonal pathway as part of its mechanism of action to reduce BP. Objectives To evaluate plasma renin activity (PRA) and aldosterone before and after RDN and to assess whether these baseline neuroendocrine markers predict response to RDN. Methods Analyses were conducted in patients with confirmed absence of antihypertensive medication. Aldosterone and PRA levels were compared at baseline and 3 months post-procedure for RDN and sham control groups. Patients in the SPYRAL HTN-OFF MED Pivotal trial were separated into 2 groups, those with baseline PRA ≥0.65 (N=110) vs. Results Baseline PRA was similar between RDN and control groups (1.0±1.1 vs. 1.1±1.1 mg/mL/hour, p=0.37). Change in PRA at 3 months from baseline was significantly greater for RDN compared with control (-0.2±1.0, p=0.019 vs. 0.1±0.9 mg/mL/hour, p=0.14), p=0.001 for RDN vs. control, and similar differences were seen for aldosterone: RDN compared with control (-1.2±6.4, p=0.04 vs. 0.4±5.4 ng/dL, p=0.40), p=0.011. Treatment differences at 3 months in 24-hour and office systolic BP (SBP) for RDN vs. control patients were significantly greater for patients with baseline PRA ≥0.65 vs. Conclusions Plasma renin activity and aldosterone levels for RDN patients were significantly reduced at 3 months when compared with baseline as well as when compared with sham control. Higher baseline PRA levels were associated with a significantly greater reduction in office and 24-hour SBP.