Reduction in BP critical for opting renal denervation over medicines for hypertension treatment

The findings of the study, published in Circulation: Cardiovascular Quality and Outcomes, imply that patients would prefer medical therapy over interventional treatments such as renal denervation, but this preference no longer holds if the interventional treatment provided more significant reductions in BP.

"The findings suggest that respondents would accept interventional treatments in exchange for modest systolic BP reductions compared with those seen in renal denervation trials," David E. Kandzari, Piedmont Heart Institute, Atlanta, GA, and colleagues wrote in their study.

The discrete choice experiment is a survey technique used to understand how people make decisions and quantify features' relative importance. Kandzari and the team using discrete choice experiment methods, quantified patient benefit–risk preferences for hypertension treatments, including pharmaceutical and interventional treatments.

Using a structured survey, the authors selected respondents from the US with physician-confirmed uncontrolled hypertension between treatments involving pills or a procedure. Treatment features included noninterventional, interventional, or no hypertension treatment; expected reduction in office systolic blood pressure; duration of effect; number of daily BP pills; risks of drug side effects, vascular injury, or access site pain. The importance of each treatment attribute was estimated using the results of a random–parameters logit model.

Four hundred patients completed the survey between 2020 and 2021; 52% were women, mean age of 59.2±13.0 years, systolic BP of 155.1±12.3 mm Hg, and 1.8±0.9 directed antihypertensive medications.

Based on the survey, the authors reported the following findings:

• Reduction in office systolic blood pressure was the most crucial treatment attribute.
• The remaining attributes, in decreasing order, were effects duration, whether treatment was interventional, the number of daily pills, vascular injury risk, and risk of drug side effects.
• The risk of access site pain did not influence choice.
• Respondents generally preferred noninterventional over interventional treatments, yet only a 2.3 mm Hg decrease in office systolic BP was needed to offset this preference.
• Small reductions in office systolic BP would offset drug side effects or vascular injury risks.
• At least a 20% risk of vascular injury or drug side effects would be tolerated in exchange for improved BP.

"We found a reduction in systolic BP to be the most important driver of patient's treatment preference, while side effects or risks from pharmaceutical or device-based therapies having much less impact," the researchers wrote.

Reference:

The study titled "Patient Preferences for Pharmaceutical and Device-based Treatments for Uncontrolled Hypertension: Discrete Choice Experiment" was published in Circulation: Cardiovascular Quality and Outcomes. DOI: https://doi.org/10.1161/CIRCOUTCOMES.122.008997