Effectiveness of Renal Denervation Therapy for?Resistant Hypertension: A Systematic Review and Meta-Analysis

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• 作者：Mark I. Davis ; Kristian B. Filion ; David Zhang ; Mark J. Eisenberg ; Jonathan Afilalo ; Ernesto L. Schiffrin ; Dominique Joyal
• 关键词：meta-analysis ; renal denervation ; resistant hypertension
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：16 July, 2013
• 年：2013
• 卷：62
• 期：3
• 页码：231-241
• 全文大小：1813 K

文摘

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lass=""h4"">Objectives

This study sought to determine the current effectiveness and safety of sympathetic renal denervation (RDN) for resistant hypertension.

lass=""h4"">Background

RDN is a novel approach that has been evaluated in multiple small studies.

lass=""h4"">Methods

We performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with resistant hypertension. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models.

lass=""h4"">Results

We identified 2 randomized controlled trials, 1 observational study with a control group, and 9 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic blood pressure (BP) at 6 months of -28.9 mm Hg (95 % confidence interval [CI]: -37.2 to -20.6 mm Hg) and -11.0 mm Hg (95 % CI: -16.4 to -5.7 mm Hg), respectively, compared with medically treated patients (for both, p?< 0.0001). In uncontrolled studies, there was a reduction in mean systolic and diastolic BP at 6 months of -25.0 mm Hg (95 % CI: -29.9 to -20.1 mm Hg) and -10.0 mm Hg (95 % CI:?-12.5 to -7.5 mm Hg), respectively, compared with pre-RDN values (for both, p?< 0.00001). There was no difference in the effect of RDN according to the 5 catheters employed. Reported procedural complications included 1 renal artery dissection and 4 femoral pseudoaneurysms.

lass=""h4"">Conclusions

RDN resulted in a substantial reduction in mean BP at 6 months in patients with resistant hypertension. The decrease in BP was similar irrespective of study design and type of catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN.