Efficacy and Safety of Ultrasound Renal Denervation on Office Blood Pressure of Patients with Resistant Arterial Hypertension: A Systematic Review and Meta-analysis.

Introduction: Resistant arterial hypertension (RAH) is one of the main causes of increased cardiovascular risk around the world. The benefits of ultrasound renal denervation (uRDN) as a non-invasive treatment are still not fully clear.

Aim:  We aim to demonstrate the efficacy of uRDN in reducing office blood pressure of patients in treatment for RAH.

Methods: PubMed, Embase, and Cochrane were searched for randomized trials comparing uRDN to sham or medical control groups in RAH patients undergoing renal denervation. Mean Differences (MD) with 95% confidence intervals (CIs) were calculated, and I² statistics assessed heterogeneity. Statistical significance was set at p < 0.05. Statistical analysis was performed using R software version 4.2.3.

Results: It was included 5 studies with 709 patients, of which 395 (55.71%) received uRDN treatment and 314 (44.29%) in the sham group. Mean follow-up time ranged from 2 to 48 months and mean age ranged from 52.3 to 62 years. The uRDN decreased systolic blood pressure (SBP) and diastolic blood pressure (DBP) in all measures significantly, including reductions in Office SBP (MD - 4.459 mmHg; 95% CI - 7.710 to - 1.208; p = 0.007; I² = 47%) and Office DBP (MD - 2.039 mmHg; 95% CI - 3.975 to - 0.102; p = 0.039; I² = 27%).

Conclusions: This meta-analysis highlights uRDN's superiority over the sham group in controlling SBP and DBP in RAH. However, further studies are needed to fully understand the efficacy of uRDN procedure in the management of RAH.