Systematic Review and Meta-Analysis of 12 Renal Denervation Studies Published

July 9, 2013—In the Journal of the American College of Cardiology (JACC), Mark I. Davis, MD, et al published a systematic review and meta-analysis of sympathetic renal denervation (RDN) to determine the therapy's current safety and effectiveness as a treatment for resistant hypertension (2013;62:231–241). The investigators noted that RDN is a novel approach that thus far has been evaluated in multiple small studies.

The investigators concluded that RDN in resistant hypertension resulted in a substantial reduction in mean blood pressure at 6 months, which was similar irrespective of study design and type of catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN, advised the investigators.

As summarized in JACC, the investigators reviewed and analyzed published studies evaluating the effect of RDN in patients with resistant hypertension. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models. They identified two randomized controlled trials, one observational study with a control group, and nine observational studies without a control group.

The investigators found that in controlled studies, there was a reduction in mean systolic and diastolic blood pressure at 6 months of -28.9 mm Hg (95% confidence interval [CI]: -37.2 to -20.6 mm Hg) and -11 mm Hg (95% confidence interval [CI], -16.4 to -5.7 mm Hg), respectively, compared with medically treated patients (for both, P < .0001). In uncontrolled studies, there was a reduction in mean systolic and diastolic blood pressure at 6 months of -25 mm Hg (95% CI, -29.9 to -20.1 mm Hg) and -10 mm Hg (95% CI, -12.5 to -7.5 mm Hg), respectively, compared with pre-RDN values (for both, P < .00001). There was no difference in the effect of RDN according to the five catheters employed. Reported procedural complications included one renal artery dissection and four femoral pseudoaneurysms, noted the investigators in JACC.