Renal Denervation Effects on Blood Pressure in Resistant and Uncontrolled Hypertension: A Meta-Analysis of Sham-Controlled Randomized Clinical Trials

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2025-03-01 DOI:10.1002/clc.70104

Hamidreza Soleimani, Babak Sattartabar, Bahar Parastooei, Reza Eshraghi, Roozbeh Nazari, Soroush Najdaghi, Sara Hobaby, Ali Etemadi, Mehrdad Mahalleh, Maryam Taheri, Adrian V. Hernandez, Toshiki Kuno, Homa Taheri, Robert J. Siegel, Florian Rader, Behnam N. Tehrani, Mohammad Hossein Mandegar, Ehsan Safaee, Pouya Ebrahimi, Kaveh Hosseini

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Abstract

Background

Although some guidelines recommend Renal denervation (RDN) as an alternative to anti-HTN medications, there are concerns about its efficacy and safety. We aimed to evaluate the benefits and harms of RDN in a systematic review and meta-analysis of sham-controlled randomized clinical trials (RCT).

Methods

Databases were searched until September 10th, 2024, to identify RCTs evaluating RDN for treating URH versus sham control. The primary outcomes were the change in office and ambulatory 24-h systolic (SBP) and diastolic blood pressure (DBP). Secondary outcomes were changes in daytime and nighttime SBP and DBP, home BP, number of anti-HTN drugs, and related complications. Mean differences (MD) and relative risks (RR) described the effects of RDN on BP and complications, respectively, using random effects meta-analyses. GRADE methodology was used to assess the certainty of evidence (COE).

Results

We found 16 included sham-controlled RCTs [RDN (n = 1594) vs. sham (n = 1225)]. RDN significantly reduced office SBP (MD −4.26 mmHg, 95% CI: −5.68 to −2.84), 24 h ambulatory SBP (MD −2.63 mmHg), office DBP (MD −2.15 mmHg), 24-h ambulatory DBP (MD −1.27 mmHg), and daytime SBP and DBP (MD −3.29 and 2.97 mmHg), compared to the sham. The rate of severe complications was low in both groups (0%–2%). The heterogeneity was high among most indices, and CoE was very low for most outcomes.

Conclusion

RDN significantly reduced several SBP and DBP outcomes versus sham without significantly increasing complications. This makes RDN a potentially effective alternative to medications in URH.

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.