AI Article Synopsis
- Sympathetic renal denervation (RD) is a potential treatment for resistant and uncontrolled hypertension, with recent trials showing effectiveness in lowering blood pressure (BP) despite earlier sham-controlled trials showing similar outcomes between RD and sham.
- A meta-analysis of seven sham-controlled trials indicates that RD significantly lowers 24-hour ambulatory systolic BP (SBP) and diastolic BP (DBP), as well as daytime SBP and DBP, but shows no meaningful impact on nighttime BP or office SBP.
- The analysis found no increased risk of hypertensive crisis between RD and sham, suggesting RD may be a safe option for managing hypertension, but more long-term studies are needed to confirm these benefits.
Article Abstract
Introduction: Sympathetic renal denervation (RD) can potentially reduce blood pressure (BP) in people with resistant hypertension (RH) and uncontrolled hypertension (UH). While a large sham-controlled trial (SCT) showed similar outcomes of RD vs. sham control, in the recent trials, RD was effective in reducing BP in hypertensive people. We performed a meta-analysis of SCTs of RD vs. sham in hypertensive patients.
Methods: Multiple electronic databases were searched since inception through September 2018 for SCTs that compared RD vs. sham. Change in 24-hour, daytime and nighttime ambulatory and office BP were efficacy outcomes. Various adverse events were safety outcomes.
Results: A total of 7 SCTs were included in the analysis. RD vs. sham significantly reduced 24-hour ambulatory SBP by 3.45 mmHg [95% CI (-5.01, -1.88); P < 0.0001] and DBP by 1.87 mmHg [(-3.59, -0.15); P = 0.01], office DBP by 2.97 mmHg [(-4.76, -1.18); P = 0.001] and daytime ambulatory SBP by 4.03 mmHg [(-6.37, -1.68); P = 0.0008] and DBP by 1.53 mmHg [(-2.69, -0.37); P = 0.01]. RD vs. sham caused non-significant reduction in office SBP by 3.99 mmHg [(-8.10, 0.11); P = 0.06] and nighttime ambulatory SBP by 3.05 mmHg [(-6.86, 0.75), P = 0.12] and DBP by 1.03 mmHg [(-3.01, 0.96); P = 0.31]. There was no difference in the risk of hypertensive crisis/emergency [0.62; 0.24-1.60; P = 0.33] between the two strategies.
Conclusions: Current meta-analysis shows that RD reduces ambulatory BP and office DBP in patients with hypertension. Future trials with longer follow-up should confirm these findings.
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| http://dx.doi.org/10.1016/j.carrev.2019.07.012 | DOI Listing |
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