Can renal denervation or spironolactone reduce blood pressure variability in resistant hypertension?

This study compared the effects of spironolactone (Aldactone) and renal denervation treatment on blood pressure variation in patients with resistant hypertension. The authors concluded that spironolactone was more effective at reducing blood pressure but renal denervation significantly reduced blood pressure variability.  

Patients with hypertension have a higher resting blood pressure than the body needs. The blood pressure needs to be lowered to avoid cardiovascular complications such as heart attacks, strokes and heart failure. Resistant hypertension, where blood pressure is consistently higher than 140/90 mm Hg, usually requires treatment with three or more drugs.

Fluctuations in blood pressure over time, also known as blood pressure variability (BPV), are also a known risk factor for cardiovascular complications. It is possible that current treatments for resistant hypertension, such as spironolactone or renal denervation may be able to lower BPV. Renal denervation is a procedure where nerve endings are disrupted with small radio pulses. This procedure is minimally invasive and has been shown to reduce blood pressure levels in resistant hypertension. It is not clear whether renal denervation is more or less effective than spironolactone in patients with resistant hypertension.

24 patients with resistant hypertension were included in this study. 13 patients received treatment with spironolactone and 11 patients underwent renal denervation treatment.

Spironolactone significantly reduced daytime systolic blood pressure (SBP – pressure when the heart is contracting) by 25.6 mmHg and daytime diastolic blood pressure (DBP – pressure when the heart is between beats) by 10.3 mmHg. Renal denervation treatment reduced daytime SBP by 3.4 mmHg and DBP by 1.8 mmHg.

Renal denervation treatment lead to significant reductions in diastolic BPV compared to spironolactone.

This study concluded that spironolactone is more effective than renal denervation in reducing day and night blood pressure. Renal denervation can significantly reduce variations in DBP compared to spironolactone. 

The number of patients included in this study is small and further studies are needed to make definite conclusions. While diastolic BPV was significantly reduced, the same effect was not seen on systolic BPV. The authors cannot provide an explanation for this.  

Consult with your physician if you would like more information on the types of treatments available for resistant hypertension.