Effectiveness of Renal Denervation in Resistant Hypertension: A Meta-Analysis of 11 Controlled Studies

• Published in: High blood pressure & cardiovascular prevention Vol. 25; no. 2; pp. 167 - 176
• Main Authors: Pappaccogli, Marco, Covella, Michele, Berra, Elena, Fulcheri, Chiara, Di Monaco, Silvia, Perlo, Elisa, Burrello, Jacopo, Monticone, Silvia, Rossato, Denis, Rabbia, Franco, Veglio, Franco
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2018; Springer Nature B.V
• Subjects: Antihypertensive Agents - therapeutic use; Antihypertensives; Blood pressure; Blood Pressure - drug effects; Cardiology; Catheters; Clinical trials; Compliance; Denervation; Diaries; Diuretics; Drug Resistance; Humans; Hypertension; Hypertension - diagnosis; Hypertension - physiopathology; Hypertension - surgery; Kidney - blood supply; Medicine; Medicine & Public Health; Meta-analysis; Pharmacotherapy; Questionnaires; Randomized Controlled Trials as Topic; Renal Artery - innervation; Review Article; Risk Factors; Statistical analysis; Sympathectomy - adverse effects; Sympathectomy - methods; Treatment Outcome; Hypertension; Renal denervation; Resistant hypertension; Drug adherence; Invasive therapy; Meta-analysis
• ISSN: 1120-9879; 1179-1985
• DOI: 10.1007/s40292-018-0260-5

Introduction Early uncontrolled studies reported large blood pressure reductions in subjects with resistant hypertension treated with renal denervation, however these results were not confirmed in several of the latest publications. Aim The aim of the current study was to evaluate the effectiveness of RDN in controlled studies comparing RDN to either a sham procedure or to medical therapy. Method Only controlled studies were included in the analysis. Both the unadjusted and control-adjusted BP changes were calculated. Results We identified 11 publications of which only 3 were double-blinded RCTs with a sham control, while 8 were open label studies where the control group was treated with medical therapy. Only 2 studies assessed adherence to medical therapy with robust methodologies. Office BP reduction (− 18/8 mmHg) significantly overestimated ABPM change (− 9/− 5 mmHg), with high heterogeneity between the included studies. When the treatment effect was adjusted for the BP change in the control group, BP changes became non significant (ABPM: − 1.8 for systolic BP [95% CI − 4.5 to 0.9] and − 0.6 for diastolic BP [95% CI − 2.3 to 1.2]). These results were confirmed when only the sham-controlled studies were analysed. Conclusions In spite of promising results in early reports, renal denervation fails to show superiority to a sham procedure or to medical therapy in recently published controlled studies. Lack of a sham control in most publications and heterogeneity in assessment of treatment adherence may account for part the variability reported in the studies. Graphical abstract Renal denervation fails to show superiority to a sham procedure or to medical therapy in recently published controlled studies.