Efficacy and Safety of Radiofrequency-Based Renal Denervation on Resistant Hypertensive Patients: A Systematic Review and Meta-analysis

• Published in: High blood pressure & cardiovascular prevention Vol. 31; no. 4; pp. 329 - 340
• Main Authors: Sobreira, Luis Eduardo Rodrigues, Bezerra, Fernando Baia, Sano, Vitor Kendi Tsuchiya, de Oliveira Macena Lôbo, Artur, Cardoso, Jorge Henrique Cavalcanti Orestes, Kelly, Francinny Alves, de Moraes, Francisco Cezar Aquino, Consolim-Colombo, Fernanda Marciano
• Format: Journal Article
• Language: English
• Published: New Zealand Springer Nature B.V 01-07-2024
• Subjects: Adult; Adults; Aged; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Antihypertensives; Bias; Blood pressure; Blood Pressure - drug effects; Catheter Ablation - adverse effects; Catheters; Citation management software; Collaboration; Denervation; Drug Resistance; Electrodes; Female; Humans; Hypertension; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - physiopathology; Hypertension - surgery; Kidney - innervation; Male; Meta-analysis; Middle Aged; Renal Artery - innervation; Renal Artery - surgery; Risk Factors; Side effects; Stroke; Sympathectomy - adverse effects; Sympathectomy - methods; Systematic review; Time Factors; Treatment Outcome; Systematic review; Resistant hypertension; Randomized controlled trial; Radiofrequency-based renal denervation; Meta-analysis
• ISSN: 1120-9879; 1179-1985
• DOI: 10.1007/s40292-024-00660-2

New therapies for resistant hypertension (RH), including renal denervation (RDN), have been studied.
Access the safety and effectiveness of radiofrequency-based RDN vs pharmacological treatment for RH.
A thorough literature search was conducted across PubMed, EMBASE, and the Cochrane databases, focusing on studies that compared the effects of radiofrequency-based RDN versus pharmacological treatment for RH. Treatment effects for binary and continuous endpoints were pooled and used, respectively, odds-ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) to analyze continuous outcomes.
In the 10 included studies, involving 1.182 patients, 682 received radiofrequency-based RDN. The follow-up period ranged from 6 to 84 months. Analysis revealed that the RDN group had a significant reduction in office systolic blood pressure (BP) (MD - 9.5 mmHg; 95% CI - 16.81 to - 2.29; P = 0.01), office diastolic BP (MD - 5.1 mmHg; 95% CI - 8.42 to - 2.80; P < 0.001), 24 h systolic BP (MD - 4.8 mmHg; 95% CI - 7.26 to - 2.42; P < 0.001). For 24 h diastolic BP RDN did not have a significant reduction (MD - 2.3 mmHg; 95% CI - 4.19 to - 0.52; P = 0.012). The heterogeneity between the studies was high, visible in the funnel and Baujat plots. The OR was non-significant for non-serious adverse events, but also clinically significant for hypertensive crises and strokes for the RDN group.
While the pharmacological regimen of 3 or more anti-hypertensive, including a diuretic, still be the first-line option for RH treatment, our results support that radiofrequency-based RDN is superior in reducing global BP and is safe.