The DENERHTN trial confirmed the daytime ambulatory systolic blood pressure (dASPB) lowering efficacy of renal denervation (RDN) added to a standardized stepped-care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months. This post-hoc analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6months.

A total of 106 patients with resistant hypertension were randomly assigned to RDN+SSAHT, or the same SSAHT alone (control group). Total AAC volume was measured from the aortic hiatus to the iliac bifurcation, blind to randomization, with semiautomatic software, on the pre-randomization non-contrast abdominal CT-scans of 90 patients and expressed as tertiles.

The baseline-adjusted difference in the change in dASBP from baseline to 6 months between the RDN and control groups was −10.1mmHg (P=0.0462) in the lowest tertile of AAC volume and −2.5mmHg (P=0.4987) in the two highest tertiles of AAC volume. Estimated glomerular filtration rate (eGFR) remained stable at 6 months in the patients with the lowest tertile of AAC volume who underwent RDN (+2.5mL/min/1.73 m²) but decreased in the control group (−8.0mL/min/1.73 m², P= 0.0148). In the two highest tertiles of AAC volume, eGFR decreased similarly in the RDN and the control groups (P=0.2640).

RDN plus SSAHT resulted in a larger decrease in dASBP than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in dASBP was not associated with a decrease in eGFR.