A META-ANALYSIS ON RENAL DENERVATION IN RESISTANT HYPERTENSION: UNVEILING THE PROMISE AND PERSISTENCE OF BLOOD PRESSURE CONTROL

Abstract

Therapeutic Area

ASCVD /CVD Risk Reduction

Background

The prevalence of resistant hypertension (RH) among treated hypertensive patients is estimated to be around 10-20%, it is expected to rise due to increasing rates of obesity, chronic kidney disease, and an aging global population. Prior studies have shown variable effects of renal denervation (RDN) on blood pressure (BP) reduction in this population, with uncertainty regarding the durability of these effects over time. This meta-analysis aims to evaluate the efficacy of RDN on BP in RH patients and compare short-term (≤6 months) and long-term (>6 months) outcomes.

Methods

We conducted a meta-analysis using the REML random-effects model. Studies reporting 24-hr ambulatory BP changes in RH patients, with intervention population undergoing RDN at beginning of study and control population not undergoing RDN at beginning of study were included. These are categorized as short-term (≤6 months) or long-term (>6 months) based on follow-up periods. Data were extracted for mean BP differences, standard deviations, and sample sizes. Forest plots were generated to visualize mean differences with 95% confidence intervals (CI), and heterogeneity was evaluated using τ2, I2, and H2 statistics, and overall effect sizes were tested using z-scores.

Results

For short-term outcomes (≤6 months), nine studies (n=771) showed a mean BP reduction of - 4.59 mmHg (95% CI: -8.60, -0.58). The overall effect was statistically significant (z=-2.24, p=0.02). For long-term outcomes (>6 months), seven studies (n=1355) demonstrated a mean BP reduction of -7.25 mmHg (95% CI: -17.50, 3.01), with no statistically significant overall effect (z=-1.39, p=0.17).

Conclusions

While the short-term outcomes revealed a statistically significant decline in 24-hr ambulatory BP (mean difference: -4.51 mmHg), the long-term efficacy revealed a sustained trend but did not reach statistical significance. These findings highlight the need for larger, standardized trials incorporating diverse populations and standardized protocols to better understand RDN’s role in RHTN management and its sustained impact on BP control.