Renal Denervation Significantly Decreases BP in Patients With Hypertension

A systematic review and meta-analysis found that renal denervation significantly reduced ambulatory and office blood pressure (BP). These findings were presented at the Transcatheter Cardiovascular Therapeutics (TCT) conference, held on November 4 to 6, 2021, and were published in JACC: Cardiovascular Interventions.

For the study, researchers searched publication databases through June 2021 for randomized, blinded, placebo-controlled studies of denervation for hypertension. A total of 7 trials comprising 1368 patients were included.

The patients were randomly assigned to receive renal denervation (n=782) or placebo (n=586). Most trials (n=5) included patients who were taking concomitant antihypertensive medications. The average weighted follow-up was 4.5 months.

Renal denervation significantly reduced 24-hour ambulatory systolic (mean difference, -3.61; 95% CI, -4.89 to -2.33 mm Hg; P <.0001; I², 0.0%) and diastolic (mean difference, -1.85; 95% CI, -2.78 to -0.92 mm Hg; P <.0001; I², 18.6%) BP.

Stratified by day and night, renal denervation significantly reduced daytime ambulatory systolic (mean difference, -4.34; 95% CI, -6.25 to -2.42 mm Hg; P <.0001; I², 22.4%) and diastolic (mean difference, -1.88; 95% CI, -2.91 to -0.85 mm Hg; P =.0003; I², 1.8%) BP as well as nighttime ambulatory systolic BP (mean difference, -3.24; 95% CI, -5.06 to -1.42 mm Hg; P =.0005; I², 0.0%), but not diastolic BP (mean difference, -1.51; 95% CI, -3.06 to 0.05 mm Hg; P =.0578; I², 67.8%).

For office BP, renal denervation significantly reduced both systolic (mean difference, -5.86; 95% CI, -7.77 to -3.94 mm Hg; P <.0001; I², 0.0%) and diastolic (mean difference, -3.63; 95% CI, -4.77 to -2.50 mm Hg; P <.0001; I², 0.0%) pressures.

Use of antihypertensive medications did not have an interaction effect with renal denervation on ambulatory systolic (P =.777) or diastolic (P =.133) BP nor on office systolic (P =.334) or diastolic (P =.392) BP.

This study was limited by the short follow-up durations and by the fact that no real-world data was included.

These data indicated that renal denervation significantly reduced ambulatory and office BP.

“Denervation could therefore be a useful strategy at various points within the hypertension journey for patients who are not willing to add antihypertensive agents,” the study authors noted.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Ahmad Y, Francis DP, Bhatt DL, Howard JP. Renal denervation for hypertension: a systematic review and meta-analysis of randomized, blinded, placebo-controlled trials. J Am Coll Cardiol Intv. Published online November 4, 2021. doi:10.1016/j.cin.2021.09.020