Efficacy and safety of renal denervation for resistant hypertension: A systematic review and meta-analysis

ZHAO Dan; WANG Xiao-qing; LIU Min; HU Yun-ke; WANG Pei-jian; ZHOU Peng

摘要：Background Renal denervation has a tortuous history.Significant reductions in blood pressure following denervation of the renal artery were observed in early trials,but subsequent denervation under sham surgery was found to be neutral.Methods This study was performed according to search results by CNKI,WANFANG DATA,EMBASE database,Pubmed,Medline,the Cochrane Central Register of Controlled Trials,Clinicaltrials.gov,and World Health Organization International Clinical Trials Registry Platform from database inception to June 20,2019.For continuous outcomes,heterogeneity were assessed by Cochran's Q test and random-effect models weighted for the inverse of the variance.Dichotomous data were analyzed using relative risk (RR) with 95％ CIs.Safety was assessed by assessing the risk of major adverse events from stratified contingency tables.Results 10 randomized controlled trials with a total of 1323 individuals were included in the quantitative analysis.Pooled analyses indicated that renal denervation was associated with a significantly greater reduction of office systolic blood pressure[mean difference (MD):-5.61 mmHg,95％ CI:-9.03 to-2.19,Z=3.21,P=0.0001]and 24-hour systolic blood pressure (MD:-4.40 mmHg,95％ CI:-14.03 to-3.83,Z=5.09,P＜0.00001) than controls.Renal denervation was not associated with an increased risk of major adverse events (RR: 1.12,95％ CI: 0.72 to 1.64,Z=0.66,P=0.51),and estimated glomerular filtration rate (eGFR)[MD: 0.35 mL/(min· 1.73 m2),95％ CI:-2.05 to 2.74,Z=0.28,P=0.78]from baseline to 6 months is statistically insignificant with significant heterogeneity.Conclusions In selected resistant hypertension patients maintained on antihypertensive drugs,renal denervation with the SYMPLICITY systems did significantly decrease blood pressure.Renal denervation was not associated with an increased risk of major adverse events.