The long term effect of renal denervation on ambulatory blood pressure in obese patients with resistant hypertension: A systematic review and meta-analysis of randomized control trials

Abstract

The global surge in obesity is emerging as a significant contemporary public health challenge, linked with an elevated occurrence of cardiovascular risks like hypertension. Obesity exacerbates the complexity of managing resistant hypertension, as it not only increases the prevalence of hypertension but also contributes to medication resistance. Renal denervation (RDN) stands as a potential approach to address resistant hypertension (RH). A systematic search was conducted through PubMed, Science Direct, and Cochrane Library selecting RCT studies until August 2023. The RCTs showed the long term effect of renal denervation on ambulatory blood pressure in individuals with both obesity and resistant hypertension. Meta-analysis was conducted using Review Manager 5.4 software. There were 9 included RCTs with total 1056 resistant hypertensive patients. Meta-analysis of the difference in changes in ambulatory systolic blood pressure was performed in nine available studies. Renal denervation showed significant ambulatory systolic blood pressure reduction (Mean Difference [MD]: -2.30; 95% CI: -4.34, -0.27; p = 0.03) and non-significant ambulatory diastolic blood pressure reduction (Mean Difference [MD]: -1.07; 95% CI: -2.94, 0.8; p = 0.26). RDN could be an additional treatment for resistant hypertension patients. RDN is not recommended to be performed routinely and not recommended for patients with secondary hypertension or eGFR less than 30 mL/min/1.73 m2.