Clinical cardiology · 2025
Renal Denervation Effects on Blood Pressure in Resistant and Uncontrolled Hypertension: A Meta-Analysis of Sham-Controlled Randomized Clinical Trials.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Soleimani Hamidreza, Sattartabar Babak, Parastooei Bahar, Eshraghi Reza, Nazari Roozbeh, Najdaghi Soroush, Hobaby Sara, Etemadi Ali, Mahalleh Mehrdad, Taheri Maryam, Hernandez Adrian V, Kuno Toshiki, Taheri Homa, Siegel Robert J, Rader Florian, Tehrani Behnam N, Mandegar Mohammad Hossein, Safaee Ehsan, Ebrahimi Pouya, Hosseini Kaveh
Аннотация
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.
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.