Blood Pressure’s Odyssey: A Systematic Exploration of long-term Renal Denervation’s Safety, Efficacy and Enduring Impact.

Background: Resistant hypertension poses a formidable challenge in contemporary cardiovascular care. Renal denervation, an evolving therapeutic strategy, offering a potential avenue for blood pressure modulation. Objective: This systematic review and meta-analysis focusing to unravel the enduring impact of renal denervation in the treatment of hypertension, particularly in cases of resistance. Method: PubMed, Cochrane, and Biomed Central databases were searched from inception to January 2024. Randomised control trial and prospective cohort that evaluate the long-term efficacy and safety in resistant hypertension were included. Risk of Bias was assessed using the Cochrane Risk odd Bias tool. Study population, method and results data were extracted and tabulated by 3 authors. Result: Five studies with total of 610 patients were included in this systematic review. All studies consistently reported significant improvements in long term blood pressure measurement. The duration of follow up varies between 6 months to 9 years. Mean change from baseline after 9 years -30.0 ± 12.7. Some studies highlight procedural complications such us 1 patient required femoral pseudoaneurysm repair, 1 haematoma at the femoral access and 1 renal artery dissection before energy delivery. Others studies highlight cardiac event such as 2 hypotensive events requiring hospitalization and 2 subjects were hospitalized with atrial fibrillation, 1 of whom underwent cardioversion. Conclusion: Synthesizing the efficacy and safety outcomes, renal denervation holds promise as a long-term strategy for blood pressure management. The consistent improvement in systolic blood pressure aligns with the goal of sustained efficacy. However, the safety considerations introduce a layer of complexity.