Effects of renal denervation on glycemic outcomes in patients with hypertension: a systematic review and meta-analysis

Background Renal denervation (RDN) lowers blood pressure in uncontrolled or resistant hypertension, but whether it produces a treatment-specific glycemic effect remains unclear. We conducted a systematic review and meta-analysis using controlled between-group comparisons as the primary evidence framework. Methods PubMed, Embase, and Web of Science were searched from January 2008 to January 2026. Prespecified glycemic outcomes included fasting glucose, HbA1c, fasting insulin, 2-h OGTT glucose, HOMA-IR, and C-peptide. Controlled between-group comparisons were prioritized, whereas RDN-arm before–after analyses were considered exploratory. Systolic and diastolic blood pressure were evaluated as reference outcomes. Exploratory study-level analyses examined whether baseline metabolic burden was associated with fasting-glucose changes. Results Twenty-four studies comprising 2,565 participants were included. Controlled analyses showed no significant between-group differences in fasting glucose (MD, −0.30 mmol/L; 95% CI, −0.73 to 0.14), HbA1c, fasting insulin, or HOMA-IR. Evidence for 2-h OGTT glucose and C-peptide was insufficient for controlled analysis. Exploratory RDN-arm before-after analyses suggested reductions in fasting glucose and HOMA-IR, but these findings were not reproduced in controlled comparisons. Controlled analyses demonstrated reductions in systolic and diastolic blood pressure. Exploratory study-level analyses suggested larger fasting-glucose reductions in populations with greater baseline metabolic burden, but these findings were sensitive to individual-study exclusions. Conclusions RDN lowered blood pressure, but current controlled evidence does not support a universal glucose-lowering effect. Exploratory findings suggest that baseline metabolic status may be related to fasting-glucose changes after RDN, although a treatment-specific benefit remains unproven. Adequately powered controlled trials in metabolically high-risk populations with prespecified primary glycemic endpoints and baseline-risk stratification are needed. Systematic review registration : PROSPERO, CRD420251047804, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251047804 .