Renal Denervation in the Management of Hypertension: A Meta-Analysis of Sham-Controlled Trials

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.