The Efficacy and Safety of Different Ways of Renal Denervation for Hypertension: A Systematic Review and Network Meta-Analysis.

This study aimed to compare the blood pressure-lowering efficacy and safety of different renal denervation (RDN) techniques. We systematically searched PubMed, Ovid, and Embase up to September 4, 2025. The primary outcome was the change in 24 h ambulatory systolic blood pressure from baseline to the end of follow-up. Secondary outcomes included changes in 24 h ambulatory diastolic blood pressure and the incidence of major adverse events. Two reviewers independently conducted study screening, data extraction, and risk of bias assessment. A network meta-analysis, along with sensitivity and subgroup analyses, was performed. Our analysis indicated that both radiofrequency RDN of the main renal artery and branches (RFB-RDN) and ultrasound RDN (US-RDN) were associated with significant reductions in 24 h ambulatory blood pressure, with comparable efficacy between the two approaches, whereas radiofrequency RDN of the main renal artery (RFM-RDN) and alcohol-mediated RDN (ALC-RDN) showed limited efficacy. Compared with sham, US-RDN and RFM-RDN showed trends toward fewer adverse events, whereas RFB-RDN and ALC-RDN exhibited numerically higher risks; however, these differences did not reach statistical significance. Subgroup analyses suggested that hypertension subtype, ethnicity, and baseline blood pressure may influence treatment effects, particularly for RFB-RDN.