Results from recent randomized placebo-controlled trials consistently indicate that renal denervation provides significant reduction in ambulatory and office blood pressure (BP), regardless of whether an individual is on antihypertensive medications or not, according to researchers presenting at TCT 2021. The findings, which were also published in JACC: Cardiovascular Interventions, suggest that denervation could be a useful strategy within the broader spectrum of BP management.

Yousif Ahmad, BMBS, PhD; Darrel P. Francis, MD; Deepak L. Bhatt, MD, MPH, FACC; and James P. Howard, MA, PhD, conducted a review and meta-analysis of 1,368 patients associated with seven randomized placebo-controlled trials of renal denervation, including RADIANCE-HTN TRIO. The primary outcome was the change in ambulatory systolic BP compared with placebo and the authors stratified their analysis based on whether patients were using background antihypertensive medication.

Overall results found denervation provided a statistically significant 3.61 mm Hg reduction in ambulatory systolic BP and a 1.85 mm Hg reduction in ambulatory diastolic BP. Additionally, a statistically significant 5.86 mm Hg reduction in office systolic BP and 3.63 mm Hg reduction in office diastolic BP was also observed.

According to the authors, the benefits of denervation were similar between patients on background antihypertensive medications and those who were not. They note that their analysis is the first to look for differences in patients using or not using these medications.

"These findings indicate that denervation could be helpful at various points within the overall strategy of BP management, including as an alternative to additional medications for patients with resistant hypertension already taking several medications or as a first-line therapy for drug-naive patients with hypertension," the authors said.

In a related editorial comment, David E. Kandzari, MD, FACC, looks at the benefits of renal denervation meta-analyses. "Considering the cadence of studies in this space, the shelf-life of [renal denervation] meta-analyses is seemingly brief as the inclusion of each additional trial leads to a new report," he writes. "As with other meta-analyses, interpretation will invariably assume a class effect to specific [renal denervation] technologies, similarity in enrollment criteria and patients, and equipoise among first generation versus more contemporary trials. Expectedly, the popularity of [renal denervation] meta-analyses will continue, yet the fairest of all will be considerate interpretation of the individual trials."

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Interventions and Imaging, Angiography, Nuclear Imaging, Hypertension

Keywords: Transcatheter Cardiovascular Therapeutics, TCT21, Angiography, Antihypertensive Agents, Blood Pressure, Hypertension, Kidney, Denervation, Family Characteristics, Pharmaceutical Preparations

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