Key result
Intravascular renal denervation significantly reduced 24-h ambulatory systolic blood pressure compared to sham control (WMD -3.02 mm Hg; 95% CI -4.95 to -1.10; p<0.01).
Why the study?
The study was designed to evaluate the antihypertensive efficacy of intravascular renal denervation in essential hypertension, particularly to determine the magnitude of blood pressure reduction achieved with second-generation catheters.
Does intravascular renal denervation reduce ambulatory and office blood pressure in patients with essential hypertension?
Meta-Analysis (n=1,297)
Sham-controlled
Randomized
Does intravascular renal denervation reduce ambulatory and office blood pressure in patients with essential hypertension?
Mean Difference: -3.02 (95% CI -4.95–-1.1)
p-value: p=< 0.01
Intravascular renal denervation, particularly with second-generation catheters, significantly reduces ambulatory and office blood pressure in patients with essential hypertension compared to sham procedures.
Supports intravascular RDN for essential hypertension; strengthens sham-controlled RCT evidence for second-generation catheters.
Background: This meta-analysis was designed to evaluate the antihypertensive efficacy of intravascular renal denervation (RDN) in patients with essential hypertension, especially to determine the magnitude of blood pressure (BP) reduction with RDN therapy using second-generation catheters. Methods: PubMed was searched to identify randomized sham-controlled trials from inception through August 2021. The endpoints were changes in 24-h ambulatory BP or office BP. This meta-analysis was performed by calculating the weighted mean difference (WMD) with 95% confidence interval (CI) using the random-effects model when the I² index was <50%. A fixed-effects model was used when the I² index was ≥50%. Results: A total of 1,297 patients were included in 8 randomized, sham-controlled trials in this meta-analysis. Intravascular RDN reduced 24-h ambulatory systolic BP (SBP) −3.02 (WMD, 95% CI: −4.95, −1.10, p < 0.01) and diastolic BP (DBP) −1.66 (WMD, 95% CI: −2.44, −0.88, p < 0.001) mm Hg, respectively. In the studies using first-generation catheters, the WMDs of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham control were −2.67 (95% CI: −5.08, −0.27; p < 0.05; I² = 0%, p = 0.53) and −0.82 (95% CI: −2.19, 0.56; p > 0.05; I² = 0%, p = 0.64) mm Hg. In the studies using second-generation catheters, the WMDs of 24-h ambulatory SBP and DBP changes between intravascular RDN and sham control were −3.14 (95% CI: −5.94, −0.33, p < 0.05; I² = 71%, p = 0.008) and −2.06 (95% CI: −3.02, −1.11, p < 0.001; I² = 50%, p = 0.09) mm Hg. Intravascular RDN using second-generation catheters reduced office SBP −6.30 (WMD, 95% CI: −7.67, −4.93, p < 0.001; I² = 43%, p = 0.14) and DBP −3.88 (WMD, 95% CI: −4.44, −3.33, p < 0.001; I² = 42%, p = 0.14) mm Hg, respectively. Conclusions: Intravascular RDN using second-generation catheters reduces ambulatory and office BP in patients with essential hypertension. The selection of appropriate hypertensive patients may be the major challenge for the performance of intravascular RDN in routine clinical practice.
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Yang et al. (2022) conducted a meta-analysis in essential hypertension (n=1,297). Intravascular renal denervation vs. Sham control was evaluated on change in 24-h ambulatory systolic BP (WMD -3.02, 95% CI -4.95, -1.10, p=< 0.01). Intravascular renal denervation significantly reduced 24-h ambulatory systolic blood pressure compared to sham control (WMD -3.02 mm Hg; 95% CI -4.95 to -1.10; p<0.01).
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