Key result
Radiofrequency shows similar 24-hour ambulatory SBP reduction to ultrasound renal denervation in hypertension.
Why the study?
Radiofrequency and ultrasound renal denervation both reduce blood pressure compared with sham in resistant hypertension, but no randomized trials have directly compared the two modalities.
Does radiofrequency renal denervation reduce 24-hour ambulatory systolic blood pressure more effectively than ultrasound renal denervation or sham in patients with hypertension on antihypertensive therapy?
Meta-Analysis (n=676)
Sham-controlled
Does radiofrequency renal denervation reduce 24-hour ambulatory systolic blood pressure more effectively than ultrasound renal denervation or sham in patients with hypertension on antihypertensive therapy?
Radiofrequency and ultrasound renal denervation provide similar blood pressure reductions as adjunctive therapy for hypertension, offering no clinical basis to prefer one device modality over the other.
Answers are grounded in this paper and cite their sources.
Equivalent reductions allow device selection by availability or preference; confirms no superiority between second-generation modalities in medicated hypertension.
Background: Radiofrequency (RF) or ultrasound (US) mediated renal denervation (RDN) have emerged as catheter-based device treatment for resistant hypertension. Both approaches effectively reduce blood pressure (BP) compared with sham, however, there are no randomized trials comparing the two modalities. Methods: A frequentist random-effects network meta-analysis was performed using second-generation sham-controlled randomized trials evaluating RDN in patients receiving antihypertensive medications. Five trials were included (SPYRAL HTN-ON MED Pilot, RADIANCE-HTN TRIO, REQUIRE, RADIOSOUND-HTN, and IBERIS-HTN; n=676). The primary outcome was change in 24-hour ambulatory systolic BP (SBP). Secondary outcomes included daytime SBP, nighttime SBP, office SBP, and 24-hour ambulatory diastolic BP (DBP). Results: In the primary analysis, neither RF (MD -5.3 mmHg, 95% CI -11.9 to 1.3) nor ultrasound RDN (MD -5.6 mmHg, 95% CI -12.4 to 1.2) reached significance versus sham, with high heterogeneity (I 2 =82.5%) and significant network inconsistency (p<0.0001), driven by the REQUIRE trial. The RF versus ultrasound difference was 0.3 mmHg (95% CI -7.5 to 8.1), indicating equivalence. On sensitivity analysis excluding REQUIRE, both RF (MD -6.3 mmHg, p=0.048) and ultrasound (MD -8.6 mmHg, p=0.029) were significant. For secondary outcomes, RF significantly reduced nighttime SBP (MD -8.9 mmHg, p<0.0001), office SBP (MD -7.5 mmHg, p<0.0001), and 24-hour DBP (MD -4.4 mmHg, p<0.0001) with zero heterogeneity. Ultrasound significantly reduced daytime SBP (MD -9.1 mmHg, p=0.029). Conclusions: In patients on antihypertensive therapy, the efficacy of BP reduction was similar between RF and US renal denervation in second-generation sham-controlled randomized trials with neither modality being superior. When methodologically robust trials are considered, second-generation RDN demonstrates consistent BP reduction as adjunct to antihypertensive therapy, with no basis for preferring one modality over the other.
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Marlecha et al. (2026) conducted a meta-analysis in Resistant hypertension on antihypertensive medications (n=676). Radiofrequency renal denervation vs. Ultrasound renal denervation and sham control was evaluated on Change in 24-hour ambulatory systolic blood pressure (MD 0.3 mmHg, 95% CI -7.5 to 8.1). Radiofrequency versus ultrasound renal denervation showed equivalent 24-hour ambulatory SBP reduction in medicated hypertensive patients.
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