Renal denervation in hypertension: An updated meta-analysis of the randomized controlled trials

Background: Radiofrequency or ultrasound renal denervation (RDN) has shown conflicting results when used as an adjunctive option for hypertension management in randomized controlled trials (RCTs). Methods: We searched Pubmed, MEDLINE, and other online databases for RCTs comparing RDN versus sham-control procedures in patients with uncontrolled or resistant hypertension. The endpoints of interest were 24-h ambulatory (AMB) blood pressure (BP), daytime AMB BP, and office BP. We performed a random-effects meta-analysis using the inverse variance method to estimate mean difference (MD) with a 95% confidence interval (CI). Results: Nine studies with 1643 patients were included in the final analysis. The mean follow-up was 5 months. As compared with the sham-controlled group, RDN was associated with a significant decrease in 24-h AMB BP (systolic [MD −4.20; 95% CI −5.36 to −3.03; p < 0.00001], diastolic [−2.38; −3.42 to −1.35]), and daytime AMB BP (systolic: −5.11; −6.75 to −3.47, diastolic: −2.88; −3.91 to −1.85). Similarly, office BP was reduced with RDN (systolic: −5.46; −7.12 to −3.81; diastolic: −3.17; −4.23 to −2.12) when compared with placebo. Conclusion: Our meta-analysis shows that RDN is associated with a significant reduction in the 24-h AMB BP, daytime AMB BP, and office BP.