Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Predictors of response to renal denervation for resistant arterial hypertension: a single center experience Miklos Rohla a , Alexander Nahler b , Thomas Lambert b , Christian Reiter b , Verena Gammer b , Michael Grund b , Hermann Blessberger b , Ju¨ rgen Kammler b , Alexander Kypta b , Karim Saleh b , Kurt Huber a , Clemens Steinwender b , and Thomas W. Weiss a Background: Renal denervation (RDN) has been shown to reduce blood pressure in patients with resistant arterial hypertension (RAH). We aimed to investigate predictors for response to RDN. Methods: Patients suffering from RAH underwent RDN after exclusion of secondary causes of hypertension. Ambulatory blood pressure measurement (ABPM) for 24 h was performed at baseline, 6 and 12 months after RDN. Response was defined as a at least 5 mmHg 24 h SBP drop at 6 months. A linear regression model was used to analyze an association between baseline variables and response to RDN. Results: In total, 45.6% of patients were responders to RDN. In those, there was a significant reduction in ABPM values at 6 and 12 months (12 months: 24 h SBP: 17.2  9.0 mmHg, P < 0.01; 24 h DBP: 9.0  11.6 mmHg, P < 0.01). Per 10 mmHg increase in baseline 24 h SBP, there was a 5.5 mmHg 24 h SBP reduction at 6 months. Per kg/m 2 increase in BMI, 24 h SBP increased by 0.7 mmHg at 6 months. Per increment in antihypertensive drugs used at baseline, there was a 2.7 mmHg 24 h SBP reduction at 6 months. Conclusion: Out of a wide range of baseline variables, elevated systolic ABPM values, BMI and the number of antihypertensive drugs used were associated with response. One has to consider the Hawthorne effect, the regression to the mean phenomenon, the actual effect of sympathetic denervation and the interaction of therapy modification when interpreting data from RDN registries without a control arm. Keywords: ambulatory blood pressure measurement, predictors for response, renal denervation Abbreviations: ABPM, ambulatory blood pressure measurement; ARB, angiotensin receptor blocker; BP, blood pressure; CCB, calcium channel blocker; Q, quartile; RAH, resistant arterial hypertension; RDN, renal denervation BACKGROUND P ercutaneous renal denervation (RDN) has been shown to reduce blood pressure in patients with resistant arterial hypertension [1,2], however, the only randomized and sham-controlled SIMPLICITY-HTN 3 (Renal sympathetic denervation in patients with treat- ment-resistant hypertension) trial could not show a benefit of RDN over optimal medical therapy [3]. Indeed, the latter trial disrupted the previous enthusiasm toward RDN as a possible new gold standard for the treatment of resistant hypertension and subsequently led healthcare providers across European countries to suspend funding for the procedure. Nevertheless, there are abundant data support- ing the ‘proof of concept’, as catheter-based renal sympath- etic denervation reduced noradrenalin spillover in humans by 47%, corresponding with sustained reductions of blood pressure (BP) up to 12 months [4]. In the Global SIMPLICITY Registry, including 1000 patients undergoing RDN at 231 sites worldwide, 68% were responders to the procedure, thus had greater than 10 mmHg reductions in office SBP (presented at the Amer- ican College of Cardiology Annual Scientific Session by M. Bo¨hm, March 2014) [5]. In the light of current data it seems that the key deter- minant for a possible future success of RDN lies in patients selection and improvements of procedural parameters [6]. An analysis from patients included into the SIMPLICITY- HTN 3 trial could show that office SBP of greater than 180 mmHg, the number of ablation attempts, aldosterone antagonist use and vasodilator nonuse were associated with response to RDN [7]. Data from other cohorts in a ‘real- world’ setting using 24-h ambulatory blood pressure Journal of Hypertension 2016, 34:123–129 a 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen hospital, Vienna and b 1st Medical Department, Cardiology, Linz General Hospital, Johannes Kepler University Medical School, Linz, Austria Correspondence to Miklos Rohla, MD, 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen hospital, Vienna, Austria. Tel: +43 1 49150 2301; fax: +43 1 49150 2309; e-mail: miklos.rohla@meduniwien.ac.at Received 16 June 2015 Revised 28 August 2015 Accepted 28 August 2015 J Hypertens 34:123–129 Copyright ß 2015 Wolters Kluwer Health, Inc. All rights reserved. DOI:10.1097/HJH.0000000000000764 Journal of Hypertension www.jhypertension.com 123 Original Article