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Effect of Catheter-Based Renal Denervation on Uncontrolled Hypertension: A Systematic Review and Meta-analysis

  • Xiaocheng Cheng
    Affiliations
    Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Dongying Zhang
    Correspondence
    Correspondence: Address to Dongying Zhang, PhD or Shu Qin, PhD, Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong district, Chongqing 400016, China.
    Affiliations
    Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Suxin Luo
    Affiliations
    Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Shu Qin
    Correspondence
    Correspondence: Address to Dongying Zhang, PhD or Shu Qin, PhD, Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong district, Chongqing 400016, China.
    Affiliations
    Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
    Search for articles by this author

      Abstract

      Objective

      To assess the efficacy and safety of catheter-based renal denervation (RDN) for the treatment of uncontrolled hypertension by conducting a systematic review and a meta-analysis.

      Methods

      The Medline, Cochrane Library, and Embase databases were searched for clinical studies between January 1, 2009, and July 16, 2018. Studies that evaluated the effect of RDN on uncontrolled hypertension were identified. The primary endpoints were changes in 24-hour ambulatory systolic blood pressure (BP) and office systolic BP. The secondary endpoints included changes in 24-hour ambulatory diastolic BP, office diastolic BP, and major adverse events.

      Results

      After a literature search and detailed evaluation, 12 randomized controlled trials with a total of 1539 individuals were included in the quantitative analysis. Pooled analyses indicated that RDN was associated with a significantly greater reduction of 24-hour systolic BP (mean difference [MD], −4.02 mm Hg; 95% CI, −5.49 to −2.56; P<.001) and office systolic BP (MD, −8.93 mm Hg; 95% CI, −14.03 to −3.83; P<.001) than controls. Similarly, RDN significantly reduced 24-hour diastolic BP (MD, −2.05 mm Hg; 95% CI, −3.05 to −1.05; P<.001) and office diastolic BP (MD, −4.49 mm Hg; 95% CI, −6.46 to −2.52; P<.001). RDN was not associated with an increased risk of major adverse events (relative risk, 1.06; 95% CI, 0.72 to 1.57; P=.76).

      Conclusions

      Catheter-based RDN was associated with a significant BP-lowering benefit without increasing major adverse events.

      Abbreviations and Acronyms:

      BP (blood pressure), MD (mean difference), RCT (randomized controlled trial), RDN (renal denervation)
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      Linked Article

      • Revisiting Renal Denervation
        Mayo Clinic ProceedingsVol. 94Issue 9
        • Preview
          The initial publication reviewing the effects of catheter-based renal denervation (RDN) in humans appeared in 2009. This open-label, nonrandomized, proof-of-principle study observed office blood pressure reductions of 22 mm Hg systolic and 11 mm Hg diastolic in drug-resistant hypertensive patients consuming an average of approximately 5 medications daily after 6 months of follow-up.1 One year later, a second study in 2010 reported a similar reduction in office blood pressures in the setting of a larger, unblinded, randomized trial.
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