Response of blood pressure to renal denervation is not associated with genetic variants

Objective: Renal denervation (RDN) is an evidence-based therapeutic option in patients with hypertension. However, the blood pressure (BP) responses to RDN in individual patients is currently impossible to predict. We conducted an unbiased genomic screen to identify genetic variants that are associated with response to RDN. Design and method: We included 268 patients (34.7% female, mean age 62 ± 10 years, BMI 30.5 ± 5.1 kg/m 2 ) with uncontrolled treatment resistant hypertension (baseline BP 166 ± 21 / 90 ± 15 mmHg) who underwent endovascular RDN using the Symplicity™ catheter (Medtronic Inc, USA). Response to 24 hour ambulatory BP was assessed after 6 months and divided into two groups, above and below the median response of 6.0 mmHg, taking pre-intervention 24-hour ambulatory BP and regression to the mean into account. Whole exome sequencing assessing 249,669 variants was conducted using Illumina NovaSeq technology read on a Nova Seq S4 Flow Cell device. Read quality was overall excellent with the eight poorest performing samples still covering 30 reads per base for 80% of the exome. Reads were analysed by a standardised variant calling pipeline, using principal component analysis followed by individual logistic regressions to model association of variants with phenotype where appropriate. Results: There has been no linkage found between individual gene variants and the response variable. These neutral findings were further confirmed after adjustment for sex and in a sensitivity analysis looking at tertiles of BP response. We also explored specific variants in AGT, ADD1, ADRB1, ADRB2 and SCNN1A that have been proposed as potential candidate genes for response of BP to RDN and again found no association (all p>0.13). Gene ontology analysis of variants across the two responder groups highlighted differences in biological processes such as cell adhesion and molecular function such as protein tyrosine kinase activity. Conclusions: Response to RDN is not robustly associated with the genetic make-up of patients with uncontrolled treatment resistant hypertension. Our data do not support the use of a genetic score to predict BP response. We found, however, different regulation of biological processes and cellular/molecular function that could provide insights into the mechanisms of RDN.