A single pharmacological or renal denervation intervention reduced 24-hour systolic ambulatory BP by 11.3 mm Hg (95% CI, -12.3 to -10.2) in patients with true resistant hypertension.
Meta-Analysis (n=6,297)
Does the addition of a single pharmacological or device-based intervention (renal denervation) improve blood pressure control in patients with true resistant hypertension?
A single additional intervention (pharmacological or renal denervation) in resistant hypertension provides meaningful BP reduction but achieves BP control in only about one-third of patients.
Mean Difference: -11.3 (95% CI -12.3–-10.2)
BACKGROUND: Resistant hypertension remains a major clinical challenge. This systematic review/meta-analysis evaluated whether the addition of a single pharmacological or device-based intervention (renal denervation RDN) can achieve effective blood pressure (BP) control in patients with true resistant hypertension. METHODS: A systematic search of MEDLINE/PubMed was performed to identify studies assessing the antihypertensive effects of adding a single pharmacological or device-based intervention in patients with true resistant hypertension. Primary analyses were conducted using a single-arm framework. RESULTS: Sixty-eight studies were included (n=6297; weighted mean age, 60 years; males 60%; diabetes 35%; smoking 16%; cardiovascular disease 27%). Participants received an average of 4.8 antihypertensive medications, with baseline office BP of 164/92 mm Hg and 24-hour ambulatory BP of 148/85 mm Hg. The median follow-up was 6 months. Meta-analysis of 58 studies (n=4579; 52% RDN) demonstrated a pooled mean 24-hour systolic ambulatory BP reduction from baseline of -11.3 mm Hg (95% CI, -12.3 to -10.2). Meta-analysis of 15 studies (n=2700; 15% RDN) showed a pooled hypertension control rate during follow-up of 35% (95% CI, 28-42). No significant differences were observed between RDN and pharmacotherapy or between randomized and nonrandomized studies. CONCLUSIONS: A single intervention-either pharmacological or RDN-on top of guideline-directed background therapy resulted in clinically meaningful BP reduction in patients with true resistant hypertension; however, only one-third of patients achieved BP control. Future clinical trials are needed to evaluate whether combination treatment strategies integrating optimized pharmacological regimens with RDN can provide more effective and durable BP control in this particularly challenging patient population.
Tsioufis et al. (Tue,) conducted a meta-analysis in true resistant hypertension (n=6,297). Single pharmacological or renal denervation intervention was evaluated on 24-hour systolic ambulatory BP reduction from baseline (MD -11.3, 95% CI -12.3 to -10.2). A single pharmacological or renal denervation intervention reduced 24-hour systolic ambulatory BP by 11.3 mm Hg (95% CI, -12.3 to -10.2) in patients with true resistant hypertension.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: