{"id":"2ea242978e8c","type":"article","url":"https://hartvaat.nl/2022/07/01/pulsatiele-hemodynamiek-voorspelt-bloeddrukrespons-op-renale-denervatie/","title":"Pulsatiele hemodynamiek voorspelt bloeddrukrespons op renale denervatie","title_en":"Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","bloeddrukbehandeling","dialyse","diuretica","endotheel","figaro-dkd","flow-trial","katheterablatie","radiance-htn","renale-denervatie","thuisbloeddrukmeting"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18641","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18641","authors":["Thomas Weber","Siegfried Wassertheurer","Christopher C Mayer","Bernhard Hametner","Kathrin Danninger","Raymond R Townsend","Felix Mahfoud","Kazuomi Kario","Martin Fahy","Vanessa DeBruin","Nicole Peterson","Manuela Negoita","Michael A Weber","David E Kandzari","Roland E Schmieder","Konstantinos P Tsioufis","Ronald K Binder","Michael Böhm"],"significance":6,"published":"2022-07-01","source_date":"2022-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This SPYRAL HTN-OFF MED analysis showed that 24-hour pulsatile hemodynamic parameters predict the blood pressure response to renal denervation, enabling individualized patient selection for device-based therapy.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de SPYRAL HTN-OFF MED-trial toonde dat 24-uurs pulsatiele hemodynamische parameters de bloeddrukrespons op renale denervatie voorspellen. Hogere uitgangspolsdruk en augmentatie-index waren geassocieerd met een grotere bloeddrukdaling, wat patiëntselectie kan verbeteren.","abstract_original":"BACKGROUND: Renal denervation (RDN) lowers blood pressure (BP), but BP response is variable in individual patients. We investigated whether measures of pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, predict BP drop following RDN. METHODS: From the randomized, sham-controlled SPYRAL HTN-OFF MED Pivotal trial, we performed a post hoc analysis of BP waveforms from 111 RDN patients and 111 sham controls, obtained with a brachial cuff-based sphygmomanometer. Waveforms were acquired during ambulatory BP monitoring at diastolic BP level and processed with validated ARCSolver algorithms to derive hemodynamic parameters (augmentation index; augmentation pressure; backward and forward wave amplitude; estimated aortic pulse wave velocity). We investigated the relationship between averaged 24-hour values at baseline and the change in 24-hour BP at 3 months in RDN patients, corrected for observed trends in the sham group. RESULTS: There was a consistent inverse relationship between baseline augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity and BP response to RDN: the decrease in 24-hour systolic BP/diastolic BP was 7.8/5.9 (augmentation index), 8.0/6.3 (augmentation pressure), 6.7/5.4 (backward wave amplitude), 5.7/4.7 (forward wave amplitude), and 7.8/5.2 (estimated aortic pulse wave velocity) mm Hg greater for patients below versus above the respective median value (P<0.001 for all comparisons, respectively). Taking augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity into account, a favorable BP response following RDN, defined as a drop in 24-hour systolic blood pressure of ≥5 mm Hg, could be predicted with an area under the curve of 0.70/0.74/0.70/0.65/0.62 (P<0.001 for all, respectively). CONCLUSIONS: These results suggest that pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, may predict BP response to RDN."}