20 THE CLINICAL SAGA OF RENAL DENERVATION IN UNCONTROLLED HYPERTENSION: AN UPDATED META-ANALYSIS OF RANDOMIZED SHAM-CONTROLLED TRIALS

Abstract

Background: Renal denervation (RDN) with catheter ablation has shown promising yet conflicting results in the management of uncontrolled hypertension. With the availability of recent randomized sham-controlled trials, we decided to perform an updated meta-analysis. Objective: To examine the utilization of renal denervation in patients with uncontrolled hypertension. Method: A systematic search in electronic databases was conducted. We included randomized sham-controlled trials comparing RDN and sham procedure in patients with uncontrolled hypertension. Included studies were evaluated for risk of bias. Our outcomes of interest were 24-hour ambulatory blood pressure (BP) and office BP. We performed fixed and random-effects meta-analysis using the inverse variance method to calculate the mean difference (MD) and 95% confidence interval (CI). Result: Final analysis included 10 studies with a total of 1,571 patients. With the median follow-up period of 6 months, RDN was associated with a significant decrease in 24-hour ambulatory BP (Systolic: MD -3.50 mmHg, 95% CI -4.75, -2.25, p<0.00001, I2=0.00; Diastolic: MD -1.97 mmHg, 95% CI -2.74, -1.20, p<0.00001, I2=0.31) compared to sham procedure. Similiarly, office BP was reduced significantly with RDN when compared to sham procedure (Systolic: MD -4.89 mmHg, 95% CI -7.67, -2.10, p=0.04, I2=0.51; Diastolic: MD -3.07 mmHg, 95% CI -4.14, -2.00, p<0.00001. I2=0.38). Further subgroup analysis showed that radiofrequency RDN was associated with a significant reduction in both 24-hour ambulatory and office BP, while ultrasound RDN was not associated with such differences. Conclusion: This updated meta-analysis suggests that RDN is associated with statistically significant improvement in uncontrolled hypertension management.