SAFETY AND EFFICACY OF RADIOFREQUENCY RENAL DENERVATION IN PATIENTS WITH PRIOR STROKE: 3-YEAR RESULTS FROM THE GLOBAL SYMPLICITY REGISTRY

Objective: Radiofrequency (RF) renal denervation (RDN) is a guideline-recommended therapy for patients with hypertension (HTN), especially those with higher risk of cardiovascular (CV) events such as stroke. Moreover, prior stroke predicts increased risk for future CV events. Herein, we assess outcomes in stroke patients from the Global SYMPLICITY Registry (GSR) through 3-years after RDN. Design and method: Blood pressure (BP) and adverse events were evaluated for high-risk stroke patients in GSR, an international, all-comers registry of RDN in patients with HTN. Measures were compared with baseline values using the paired t-test. Results: As of March 2024, 299 patients enrolled in GSR had a stroke prior to undergoing RDN. Stroke patients had a mean age of 62±11 years, 42% of whom were female, with 57% having a history of cardiac disease, 15% with atrial fibrillation, 44% with type II diabetes mellitus, 30% with chronic kidney disease (eGFR<60 mL/min/1.73m2), and 12% were current smokers. Mean baseline office systolic BP was 168±28mmHg and mean 24-h ambulatory systolic BP was 159±22 mmHg. Patients with stroke history were prescribed an average of 4.9±1.5 antihypertensive medications at baseline. At 3 years after RDN, stroke patients had a 21.4 mmHg and 11.7 mmHg reduction in office systolic and 24-h ambulatory systolic BP, respectively (both p<0.001 from baseline; Figure). The mean number of medications at 3 years was unchanged (4.6±1.6). At 3-years after RDN, the rate of death in stroke patients was 9%, with a cardiovascular death rate of 6%. The rate of recurrent stroke was 12%, and the rate for hospitalization due to hypertensive crisis/emergency was 7%.Conclusions: Stroke patients from GSR had sustained long-term BP reductions through 3 years after RF RDN. Rates of death, cerebro- and cardiovascular event rates in GSR compare favorably to those reported in contemporary population-based studies. RDN was overall safe in stroke patients and may be a suitable treatment option for high-cardiovascular risk patients with HTN in the management of high BP. Future, prospective trials are warranted to further investigate the benefits of RDN in stroke patients.