Impact of Renal Denervation on Patients With Obstructive Sleep Apnea and Resistant Hypertension – Insights From the SYMPLICITY HTN-3 Trial –
Open accessAbstract
BACKGROUND: Obstructive sleep apnea (OSA) is associated with activation of the sympathetic nervous system, and patients with this condition often experience elevated blood pressure (BP), increased BP variability, and nocturnal BP surges. METHODS AND RESULTS: The SYMPLICITY HTN-3 trial was a large prospective, randomized, blinded, sham-controlled trial of renal denervation for treatment of uncontrolled, apparently treatment-resistant hypertension. In a post hoc analysis, we examined the effect of renal denervation vs. sham control on office and ambulatory (including nocturnal) systolic BP in patients with and without OSA. 26% (94/364) of renal denervation subjects and 32% (54/171) of sham control subjects had OSA. Baseline office and nighttime systolic BP values were similar in both arms, including in subjects with and without OSA. Compared with sham control, renal denervation reduced the 6-month office systolic BP in subjects with (-17.0±22.4 vs. -6.3±26.1 mmHg, P=0.01) but not in subjects without OSA (-14.7±24.5 vs. -13.4±26.4 mmHg, P=0.64), P=0.07 for the interaction between treatment arm and OSA status. In those with sleep apnea, renal denervation was also associated with a reduction in maximum (-4.8±21.8 vs. 4.5±24.6 mmHg, P=0.03) and average peak (-5.6±20.4 vs. 3.2±22.4 mmHg, P=0.02) nighttime systolic BP. CONCLUSIONS: OSA subjects appeared to be responsive to renal denervation therapy. However, this hypothesis requires prospective testing. (Circ J 2016; 80: 1404-1412).
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Renal denervation did not lower office systolic blood pressure in patients without sleep apnea.
“Renal denervation did not lower office SBP in patients without sleep apnea.”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [56]
In adults with severe uncontrolled resistant hypertension and self-reported sleep apnea in the SYMPLICITY HTN-3 trial, renal denervation lowered office systolic blood pressure more effectively relative to sham controls at 6 months (−17.0 mm Hg versus −6.3 mm Hg; P<0.01).
“In adults with severe uncontrolled RH and self-reported sleep apnea in the SYMPLICITY HTN-3 trial (Renal Denervation in Patients With Uncontrolled Hypertension), renal denervation lowered office systolic BP (SBP) more effectively relative to sham controls at 6 months (−17.0 mm Hg versus −6.3 mm Hg; P<0.01).56”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [56]
In a post hoc analysis of the SYMPLICITY HTN-3 trial, renal denervation reduced the 6-month office systolic blood pressure in subjects with obstructive sleep apnea compared with sham control.
“Compared with sham control, renal denervation reduced the 6-month office SBP in subjects with OSA.56”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [56]
Systolic blood pressure, diastolic blood pressure, and heart rate increase the day after a sleep-deprived night compared with the day after a normal sleep; urinary excretion of norepinephrine is also increased.
“SBP, diastolic BP, and heart rate increase the day after a sleep-deprived night compared with the day after a normal sleep; urinary excretion of norepinephrine is also increased.56,253–256”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [56]
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- Authors
- Kario, K., Bhatt, D. L., Kandzari, D. E., Brar, S., Flack, J. M., Gilbert, C., Oparil, S., Robbins, M., Townsend, R. R., & Bakris, G.
- Affiliations
- Jichi Medical University (JP)
- Brigham and Women's Hospital (US)
- Piedmont Atlanta Hospital (US)
- Medtronic (United States) (US)
- SIU Medicine (US)
- University of Alabama (US)
- Vanderbilt University (US)
- University of Pennsylvania (US)
- University of Chicago (US)
- ORCID
- Venue
- Circulation Journal
- Publisher
- Japanese Circulation Society
- Published
- 2016
- Volume
- 80
- Issue
- 6
- Pages
- 1404-1412
- ISSN
- 1346-9843 (ISSN-L)
- 1347-4820
- OpenAlex
- W2344184152
- Cited by
- 84
- References
- 43
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 11 · 2023: 9 · 2022: 5 · 2021: 5 · 2020: 8 · 2019: 10 · 2018: 12 · 2017: 8 · 2016: 11
- FWCI
- 11.25
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Circulation Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Bristol-Myers Squibb
- Pfizer
- AstraZeneca
- Bayer
- Sanofi
- Boston Scientific Corporation
- Boston VA Research Institute
- Regeneron Pharmaceuticals
- Amarin Corporation
- Medicines Company
- Omron Healthcare
- Regado Biosciences
- Belvoir Media Group
- Dainippon Sumitomo Pharma
- Eisai
- Astellas Pharma
- Teijin Pharma
- St. Jude Medical
- Relypsa
- Duke Clinical Research Institute
- Janssen Pharmaceuticals
- Daiichi Sankyo Europe
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- renal denervation, obstructive sleep apnea, resistant hypertension, Symplicity HTN-3 trial, nocturnal blood pressure, sympathetic activation, ambulatory blood pressure, treatment-resistant hypertension
- MeSH terms
- Adult, Aged, Blood Pressure, Denervation, Drug Resistance, Female, Humans, Hypertension, Kidney, Male, Middle Aged, Renal Artery, Sleep Apnea, Obstructive
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