Key result
Renal denervation lowers 24-hour ambulatory systolic BP by ~4 mm Hg vs. sham control.
Why the study?
There are conflicting data regarding the relative effectiveness of renal sympathetic denervation in patients with hypertension.
Does catheter-based renal sympathetic denervation reduce blood pressure in patients with hypertension compared to a sham procedure?
Meta-Analysis (n=977)
Sham-controlled
Does catheter-based renal sympathetic denervation reduce blood pressure in patients with hypertension compared to a sham procedure?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Recent data, including those from our meta-analysis, suggest that the blood pressure lowering effect of RSD, even if smaller than initially anticipated, is similar to that observed with many currently approved antihypertensive drugs, and of a magnitude that should translate into significantly lower cardiovascular event risk.”
“It's not just about lowering blood pressure for the sake of lowering it. Many people have blood pressure elevated significantly and even a small reduction beyond what they might have achieved on medication is likely to effect a significant reduction in adverse events. We know this from multiple trials of drug therapy for hypertension.”
“Meta-analyses of randomized trials of renal denervation showed reductions in 24-hour ambulatory blood pressure, with a mean difference of −4.02/−2.05 mm Hg compared with controls, and a mean difference of −3.65/−1.71 mm Hg when the analysis was restricted to sham-controlled randomized trials, suggesting a modest effect size.”
Catheter-based renal sympathetic denervation significantly reduces ambulatory and office blood pressure in hypertensive patients compared with a sham procedure, supporting its efficacy as an interventional treatment.
BACKGROUND There are conflicting data regarding the relative effectiveness of renal sympathetic denervation (RSD) in patients with hypertension. OBJECTIVES The purpose of this study was to evaluate the blood pressure (BP) response after RSD in sham-controlled randomized trials. METHODS Databases were searched through June 30, 2018. Randomized trials (RCTs) with ≥50 patients comparing catheter-based RSD with a sham control were included. The authors calculated summary treatment estimates as weighted mean differences (WMD) with 95% confidence intervals (CIs) using random-effects meta-analysis. RESULTS The analysis included 977 patients from 6 trials. The reduction in 24-h ambulatory systolic blood pressure (ASBP) was significantly greater for patients treated with RSD than sham procedure (WMD -3.65 mm Hg, 95% CI: -5.33 to -1.98; p < 0.001). Compared with sham, RSD was also associated with a significant decrease in daytime ASBP (WMD -4.07 mm Hg, 95% CI: -6.46 to -1.68; p < 0.001), office systolic BP (WMD -5.53 mm Hg, 95% CI: -8.18 to -2.87; p < 0.001), 24-h ambulatory diastolic BP (WMD -1.71 mm Hg, 95% CI: -3.06 to -0.35; p = 0.01), daytime ambulatory diastolic BP (WMD -1.57 mm Hg, 95% CI: -2.73 to -0.42; p = 0.008), and office diastolic BP (WMD -3.37 mm Hg, 95% CI: -4.86 to -1.88; p < 0.001). Compared with first-generation trials, a significantly greater reduction in daytime ASBP was observed with RSD in second-generation trials (6.12 mm Hg vs. 2.14 mm Hg; p interaction = 0.04); however, this interaction was not significant for 24-h ASBP (4.85 mm Hg vs. 2.23 mm Hg; p interaction = 0.13). CONCLUSIONS RSD significantly reduced blood pressure compared with sham control. Results of this meta-analysis should inform the design of larger, pivotal trials to evaluate the long-term efficacy and safety of RSD in patients with hypertension.
No takes yet. Share an insight, caveat, or question.
Sardar et al. (2019) conducted a meta-analysis in Hypertension (n=977). Catheter-based renal sympathetic denervation (RSD) vs. Sham control was evaluated on 24-h ambulatory systolic blood pressure (ASBP) (WMD -3.65 mm Hg, 95% CI -5.33 to -1.98, p=< 0.001). Catheter-based renal sympathetic denervation significantly reduced 24-h ambulatory systolic blood pressure compared with sham control (WMD -3.65 mm Hg; 95% CI: -5.33 to -1.98; p < 0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: