Ocílio Ribeiro Gonçalves, Francinny Alves Kelly, José Guilherme Maia, Artur de Oliveira Macena Lôbo, Vitor Kendi Tsuchiya Sano, Maria Eduarda Cavalcanti Souza, Francisco Cezar Aquino de Moraes, Nimra Farid, Arlindo Bispo da Silva Júnior, Avelar Alves da Silva
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Statistical analyses were performed using R Studio 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was examined with the Cochran Q test I<sup>2</sup> statistics. Mean difference (MD) with 95% confidence interval (CI) were pooled across trials. <i>P</i> values of <0.05 were considered statistically significant. The primary outcomes of interest were changes from baseline in systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum creatinine.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Twenty-one RCTs comprising 3345 patients were included in this meta-analysis, whereby 2004 (59.91%) received renal denervation and 1341 (40.09%) received pharmacological treatment or sham procedure. Follow-up ranged from 2 to 48 months. Compared to control group, RDN significantly reduced SBP (MD −3.53 mm Hg; 95% CI −5.94 to −1.12; <i>p</i> = 0.004; I<sup>2</sup> = 74%) and DBP (MD −1.48 mm Hg; 95% CI −2.56 to −0.40; <i>p</i> = 0.007; I<sup>2</sup> = 51%). 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引用次数: 0
摘要
背景肾脏去神经支配（RDN）是一种创新手术，旨在调节肾脏交感神经系统以控制动脉高血压（HTN）。RDN 已成为耐药性高血压患者的替代治疗方法。方法在 PubMed、Embase 和 Cochrane 数据库中检索随机对照试验（RCT），比较 RDN 与假手术或药物治疗在耐药性高血压患者中的应用。统计分析使用 R Studio 4.3.2（奥地利维也纳 R 统计计算基金会）进行。异质性用 Cochran Q 检验 I2 统计量进行检验。对各试验的平均差（MD）和 95% 置信区间（CI）进行了汇总。P值为<0.05被认为具有统计学意义。研究的主要结果是收缩压（SBP）、舒张压（DBP）和血清肌酐与基线相比的变化。结果21项RCT研究共纳入3345名患者，其中2004人（59.91%）接受了肾脏去神经支配，1341人（40.09%）接受了药物治疗或假手术。随访时间从 2 个月到 48 个月不等。与对照组相比，RDN 能显著降低 SBP（MD -3.53 mm Hg; 95% CI -5.94 to -1.12; p = 0.004; I2 = 74%）和 DBP（MD -1.48 mm Hg; 95% CI -2.56 to -0.40; p = 0.007; I2 = 51%）。关于血清肌酐（MD -2.51；95% CI -7.90至2.87；p = 0.36；I2 = 40%），RDN组和对照组之间没有显著差异。
Assessing the efficacy of renal denervation in patients with resistant arterial hypertension
Background
Renal denervation (RDN) is an innovative procedure designed to regulate the renal sympathetic nervous system for the control of arterial hypertension (HTN). RDN has emerged as an alternative for patients with resistant HTN. However, the clinical efficacy of RDN remains incompletely elucidated.
Methods
PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing the use of RDN with sham procedure or pharmacological treatment in patients with resistant HTN. Statistical analyses were performed using R Studio 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was examined with the Cochran Q test I2 statistics. Mean difference (MD) with 95% confidence interval (CI) were pooled across trials. P values of <0.05 were considered statistically significant. The primary outcomes of interest were changes from baseline in systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum creatinine.
Results
Twenty-one RCTs comprising 3345 patients were included in this meta-analysis, whereby 2004 (59.91%) received renal denervation and 1341 (40.09%) received pharmacological treatment or sham procedure. Follow-up ranged from 2 to 48 months. Compared to control group, RDN significantly reduced SBP (MD −3.53 mm Hg; 95% CI −5.94 to −1.12; p = 0.004; I2 = 74%) and DBP (MD −1.48 mm Hg; 95% CI −2.56 to −0.40; p = 0.007; I2 = 51%). Regarding serum creatinine (MD −2.51; 95% CI −7.90 to 2.87; p = 0.36; I2 = 40%), there was no significant difference between RDN and control groups.
Conclusion
In this meta-analysis of RCTs of patients with resistant HTN, RDN was associated with a reduction in SBP and DBP compared to sham procedure or pharmacological treatment.
期刊介绍：
Herz is the high-level journal for further education for all physicians interested in cardiology. The individual issues of the journal each deal with specific topics and comprise review articles in English and German written by competent and esteemed authors. They provide up-to-date and comprehensive information concerning the speciality dealt with in the issue. Due to the fact that all relevant aspects of the pertinent topic of an issue are considered, an overview of the current status and progress in cardiology is presented. Reviews and original articles round off the spectrum of information provided.
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