EFFECT OF RENAL DENERVATION ON AMBULATORY BLOOD PRESSURE IN PATIENTS WITH UNCONTROLLED HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, SHAM-CONTROLLED TRIALS. (April 2021)

• Record Type: Journal Article
• Authors: Stavropoulos, Konstantinos; Patoulias, Dimitrios; Katsimardou, Alexandra; Imprialos, Konstantinos; Koutsampasopoulos, Konstantinos; Toumpourleka, Maria; Sachinidis, Alexandros; Dimitriadis, Kyriakos; Papademetriou, Vassilios; Tsioufis, Konstantinos; Doumas, Michael
• Is Part Of: Journal of hypertension. Volume 39(2021)e-Supplement 1
• Publication Date: 2021-04
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000747788.40711.72
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Untreated and uncontrolled hypertension remains among the most important cardiovascular risk factors worldwide, while hypertension treatment and control rates remain low in many countries. The aim of this study was to meta-analyze the effects of renal denervation (RDN) on ambulatory blood pressure levels in patients with untreated or uncontrolled hypertension. Design and method: PubMed and CENTRAL, along with grey literature sources, were searched from their inception to May 2019 for randomized, sham-controlled trials evaluating the efficacy and safety of RDN on the management of hypertension, irrespective of study blinding, setting and sample size. Results: Six randomized, sham-controlled trials were identified and included in the meta-analysis. In total, 981 patients with hypertension were randomized in all 6 trials to undergo either RDN (n = 585) or sham-procedure (n = 396). Compared to sham, RDN resulted in a decrease in 24-h systolic ambulatory blood pressure (ABP) by 3.62 mmHg (95% CI: -5.28 to -1.96; I^2 = 0%) and in 24-h diastolic ABP by 1.92 mmHg (95% CI: -3.65 to -0.20; I^2 = 46%). Grade of evidence was rated as low for both outcomes. Further analysis documented that RDN decreased daytime systolic ABP by 5.51 mmHg (95% CI: -7.79 to -3.23; I2 = 0%), nighttime systolic ABP by 3.06 mm Hg (95% CI: -8.69 to 2.56; I^2 = 73%), daytime diastolic ABP by 1.90 mmHg (95% CI: -3.48 to -0.32; I^2 = 4%) and nighttime diastolic ABP by 0.80 mmHg (95% CI: -3.61 to 2.02; I2 = 57%), compared to sham procedure. No major safety issues were identified. Conclusions: RDN is associated with a significant reduction in both 24-h systolic and diastolic ABP levels. Importantly, RDN decreases significantly daytime ABP levels, while it does not consistently induce a substantial reduction in nighttime ABP levels.