Abstract 4358422: Comparative Efficacy and Safety of Renal Denervation Versus Spinal Cord Stimulation in Hypertensive Patients: A Propensity-Matched Cohort Study

Introduction: Hypertension remains a leading contributor to cardiovascular morbidity and mortality despite advances in pharmacotherapy and device-based interventions. Renal denervation (RDV) and spinal cord stimulation (SCS) have emerged as alternative therapies targeting neurohormonal pathways to achieve blood pressure control. Yet direct comparisons of their efficacy and safety in real-world populations are lacking. We aimed to compare outcomes following RDV versus SCS in hypertensive adults using a large propensity-matched cohort. Methods: We performed a retrospective cohort study through the TriNetX Global Collaborative Network, identifying adults (≥18 years) with hypertension who underwent first-ever RDV or SCS between January 2019 and October 2024. Outcomes assessed at 4-, 12-, and 26-weeks post-procedure included blood pressure targets (SBP ≤130/≤140 mm Hg; DBP ≤80/≤90 mm Hg), acute kidney injury (AKI), major adverse cardiovascular events (MACE), electrolyte disturbances (hyper-/hypokalemia, hyper-/hyponatremia), serious adverse events, procedure-related complications, and all-cause mortality. Baseline characteristics were balanced by 1:1 propensity-score matching demographics, comorbidities, and antihypertensive medications. Results: After matching (n=307 per group; 49.8 % male), SCS achieved superior blood pressure control by 12 and 26 weeks: at 12 wk DBP ≤80 mm Hg (RR 0.79; P=0.002) and combined SBP/DBP targets (RR 0.86; P<0.001), and at 26 wk SBP ≤130 mm Hg (RR 0.85; P=0.044), SBP ≤140 mm Hg (RR 0.82; P=0.004), DBP ≤80 mm Hg (RR 0.84; P=0.019), and DBP ≤90 mm Hg (RR 0.84; P=0.011). RDV was associated with higher risks of hypokalemia (4 wk RR 4.10; P<0.001; 26 wk RR 2.70; P<0.001), serious adverse events (4 wk RR 2.12; P=0.001; 26 wk RR 1.46; P=0.005), hyponatremia (4 wk RR 4.20; P<0.001; 26 wk RR 2.61; P<0.001), MACE (26 wk RR 3.50; P<0.001), and all-cause mortality (26 wk RR 2.40; P=0.013). Conclusion: In this large real-world cohort, SCS provided more sustained blood pressure reduction with fewer serious complications compared to RDV. These findings support consideration of SCS as a preferable neurostimulation strategy for patients with resistant hypertension.