Regression of organ damage following renal denervation in resistant hypertension: a meta-analysis

Prospective observational studies have suggested that renal denervation (RDN) is associated with target organ damage (TOD) regression. Our aim is to review and meta-analyze the available evidence for the effect of RDN on TOD.

We searched literature for studies with eligible content and performed random-effect meta-analyses for the following outcomes: left ventricular mass index (LVMI), left atrial volume index (LAVI), E to A wave velocities of trans-mitral inflow (E/A) and E wave velocity to Em velocity from tissue Doppler imaging (E/Em), central augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV).

Seventeen studies (n = 698 patients) were incorporated in the present meta-analysis. RDN led to a regression of LVMI by 14.17 g/m (95% CI -18.33 to -10.01, P < 0.001) and by 4.75 g/m (95% CI -7.83 to -1.67, P = 0.003) for echocardiography and cardiac magnetic resonance, respectively. The pooled effect of RDN to E/A was not significant [0.04 (95% CI -0.03 to 0.12, P = 0.252)], whereas a decline of E/Em [-0.73 (95% CI -1.38 to -0.08, P = 0.03)] was observed. The pooled effect to LAVI [-1.67 ml/m (95% CI -4.60 to 1.27, P = 0.266)] reached statistical significance only in sensitivity analysis. RDN had beneficial effects in both AIx [-7.05 (95% CI -9.12 to -4.98, P < 0.001)] and PWV [1.54 m/s (95% CI -2.16 to -0.92, P < 0.001)]. Metaregression analysis revealed an independent effect of RDN on TOD regarding baseline blood pressure and blood pressure reduction.

Catheter-based RDN can favorably affect TOD.