Effectiveness of Renal Denervation Therapy for Resistant Hypertension: A Systematic Review and Meta-Analysis
What is the effectiveness and safety of sympathetic renal denervation (RDN) for resistant hypertension (RH)?
The authors performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with RH. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models.
The authors identified two randomized controlled trials, one observational study with a control group, and nine observational studies without a control group. A total of five different catheters were used across these trials. In controlled studies, there was a reduction in mean systolic (-28.9 mm Hg; 95% confidence interval [CI], -37.2 to -20.6; p < 0.0001) and diastolic (-11.0 mm Hg; 95% CI, -16.4 to -5.7; p < 0.0001) blood pressure (BP) at 6 months compared to medically treated patients. In uncontrolled studies, there was a similar reduction in mean systolic (-25.0 mm Hg; 95% CI, -29.9 to -20.1) and diastolic (-10.0 mm Hg; 95% CI, -12.5 to -7.5) blood pressure at 6 months compared to pre-RDN values. There was no difference in the effect of RDN according to the type of the device used. Reported procedural complications included one renal artery dissection and four femoral pseudoaneurysms.
The authors concluded that RDN resulted in a substantial reduction in BP in patients with RH.
RDN is one of the most innovative advances in hypertension in the last few years. The results of this meta-analysis confirm the efficacy (substantial reduction in BP) and the overall safety of the procedure. The ongoing SYMPLICITY-3 trial will help establish the clinical role of this procedure, although I suspect that RDN will become the preferred therapy for RH. Further research is warranted to assess the benefit of this therapy in patients who are not truly resistant, but whose BP remains suboptimally controlled due to noncompliance or intolerance of multiple medications.
Keywords: Aneurysm, False, Renal Artery, Denervation, Blood Pressure, Blood Pressure Determination, Hypertension
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