Randomized Trials of Renal Denervation for Uncontrolled Hypertension: An Updated Meta-Analysis.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Hypertension Management

Background:

• A significant number of patients have uncontrolled blood pressure despite optimal medical therapy.
• Catheter-based renal denervation (RDN) is an emerging intervention for resistant hypertension.
• The differential efficacy of RDN in patients on versus off antihypertensive medications requires further elucidation.

Purpose of the Study:

• To conduct an updated meta-analysis assessing the efficacy and safety of RDN in patients with uncontrolled hypertension.
• To specifically evaluate the effect of RDN on blood pressure in patients taking antihypertensive medications compared to those not on medication.
• To analyze the consistency of RDN efficacy across different trial designs and device approvals.

Main Methods:

• A systematic search of online databases identified relevant randomized clinical trials.
• Included trials compared RDN to a sham procedure in patients with uncontrolled hypertension.
• Subgroup analyses focused on sham-controlled trials and those using US Food and Drug Administration-approved RDN devices.

Main Results:

• Fifteen trials involving 2581 patients were analyzed.
• RDN significantly reduced systolic blood pressure in patients both off and on antihypertensive medications.
• Significant reductions in diastolic blood pressure were also observed in patients on antihypertensive medications.

Conclusions:

• RDN is an effective treatment for lowering blood pressure in patients with uncontrolled hypertension.
• The procedure is safe and effective in both patients on and off antihypertensive medications.
• RDN efficacy is consistent across sham-controlled and contemporary trials using FDA-approved devices.