USA: Renal denervation significantly reduces ambulatory and office blood pressure, show findings from a meta-analysis. The researchers further add that the magnitude of benefit although is modest (about 4/2 mm Hg), was found to be similar between patients on background antihypertensive medications and those not on it.
The findings, published in the journal JACC: Cardiovascular Interventions, therefore imply that denervation could be useful for patients who do not want to add antihypertensive agents.
Renal denervation effectiveness for BP reduction has been controversial. Early unblinded trials have shown an effect size of BP reduction and are completely distinct in magnitude from that shown in the first blinded placebo-controlled trials. Denervation now has been evaluated in several placebo-controlled trials. These trials cover the spectrum from patients with drug-resistant hypertension to those not yet taking antihypertensive medications.
In the updated meta-analysis of randomized, blinded, placebo-controlled trials of denervation, Yousif Ahmad, Yale School of Medicine, Yale University, New Haven, Connecticut, USA, and colleagues specifically compared the effect of renal denervation in patients taking medications and in those not taking medications.
For this purpose, the researchers identified all blinded placebo-controlled randomized trials of catheter-based renal sympathetic denervation for hypertension and performed a random-effects meta-analysis. The primary efficacy outcome was the change in ambulatory systolic blood pressure beyond the effect of the placebo procedure.
The analysis was stratified by if there was background antihypertensive medication use. A total of 7 eligible trials, involving 1,368 patients were included.
Based on the study, the researchers found the following:
Denervation significantly reduced ambulatory systolic (mean difference −3.61 mm Hg), ambulatory diastolic (−1.85 mm Hg), office systolic (−5.86 mm Hg), and office diastolic (−3.63 mm Hg) blood pressure.
There was no evidence that the use of concomitant antihypertensive medication had a significant impact on the effect of denervation on any of these endpoints.
"RCTs consistently showed that denervation provides a significant reduction in office and ambulatory BP. The magnitude of benefit although is modest. it is the same between patients on background antihypertensive medications and those who are not," wrote the authors.
"These findings imply that denervation could be a useful strategy at various points within the hypertension journey for patients who are not willing to add antihypertensive agents," they concluded. "Whether the effect fades with time is unknown and may not ever be known."
Reference:
The study titled, "Renal Denervation for Hypertension: A Systematic Review and Meta-Analysis of Randomized, Blinded, Placebo-Controlled Trials," was published in the journal JACC: Cardiovascular Interventions.
DOI: https://doi.org/10.1016/j.jcin.2021.09.020