Long-term effects of renal denervation on hypertension management: insights from an ESH center of excellence and a meta-analysis of current evidence

Background: Renal denervation (RDN) has been approved in Europe and the United States and is recommended by the ESH and ESC hypertension guidelines as a therapeutic option for patients with resistant or uncontrolled hypertension. The aim of this study was to evaluate the long-term outcomes of radiofrequency (RF) RDN in a cohort of patients treated at an ESH center of excellence, with a mean follow-up of 8 years, and to review current evidence on the durability and safety of the procedure. Methods: From a pool of patients with uncontrolled hypertension who had previously undergone RF RDN, we included those with a follow-up longer than 3 years ( n = 97). Baseline and follow-up data were collected for each patient, including office blood pressure (OBP), ambulatory blood pressure (ABP), use of antihypertensive medication, and markers of renal function. A propensity-matched control group of patients with resistant hypertension managed conservatively (without RDN) was selected for comparison. All-cause mortality and nonfatal cardiovascular events were recorded. Additionally, we conducted a systematic review and meta-analysis of studies reporting RDN outcomes with follow-up periods exceeding 3 years. Results: A total of 76 patients (mean age 61.4 ± 10.5 years, 25% female) had follow-up data over a mean of 8.3 ± 3.4 years. OBP decreased significantly from baseline by 21.8 ± 16.9 mmHg systolic and 13.1 ± 9.6 mmHg diastolic ( P < 0.001 for both). In 41 patients with ABP data, systolic ABP decreased by 19.4 ± 13.1 mmHg and diastolic ABP by 12.7 ± 10.0 mmHg ( P < 0.001 for both). The number of prescribed antihypertensive medications was reduced by 0.54 ± 1.2 ( P < 0.01). By the end of follow-up, 9 of the 97 RDN patients (9.3%) had died, compared with 5 of 44 control patients (11.4%) over a mean follow-up of 8.1 ± 2.3 years. Twelve patients were lost to follow-up. Estimated glomerular filtration rate declined significantly in the RDN group from 83.0 ± 14.4 to 75.5 ± 19.2 mL/min/1.73 m 2 ( P < 0.001). A meta-analysis of eight studies, including ours, with a mean follow-up of 8.7 years, showed a reduction in 24-h systolic ABP of −15.7 mmHg [95% confidence interval (CI): −18.4 to −13.0] and diastolic ABP of −9.2 mmHg (95% CI: −10.5 to −7.9), consistent with our findings. No major adverse events were reported. Conclusion: RDN is a safe procedure that provides durable antihypertensive effects lasting for at least 8 years.