Renal Denervation Effects on Blood Pressure in Resistant and Uncontrolled Hypertension: A Meta-Analysis of Sham-Controlled Randomized Clinical Trials Publisher Pubmed

Summary: Meta-analysis shows renal denervation significantly lowers blood pressure in resistant hypertension with low complications, offering a potential alternative to drugs. #Hypertension #RenalDenervation

Soleimani H¹ ; Sattartabar B² ; Parastooei B² ; Eshraghi R³ ; Nazari R⁴ ; Najdaghi S⁵ ; Hobaby S⁶ ; Etemadi A⁷ ; Mahalleh M² ; Taheri M⁸ ; Hernandez AV^{9, 10} ; Kuno T¹¹ ; Taheri H¹² ; Siegel RJ¹² Show All Authors
Source: Clinical Cardiology Published:2025

Abstract

Background: Although some guidelines recommend Renal denervation (RDN) as an alternative to anti-HTN medications, there are concerns about its efficacy and safety. We aimed to evaluate the benefits and harms of RDN in a systematic review and meta-analysis of sham-controlled randomized clinical trials (RCT). Methods: Databases were searched until September 10th, 2024, to identify RCTs evaluating RDN for treating URH versus sham control. The primary outcomes were the change in office and ambulatory 24-h systolic (SBP) and diastolic blood pressure (DBP). Secondary outcomes were changes in daytime and nighttime SBP and DBP, home BP, number of anti-HTN drugs, and related complications. Mean differences (MD) and relative risks (RR) described the effects of RDN on BP and complications, respectively, using random effects meta-analyses. GRADE methodology was used to assess the certainty of evidence (COE). Results: We found 16 included sham-controlled RCTs [RDN (n = 1594) vs. sham (n = 1225)]. RDN significantly reduced office SBP (MD −4.26 mmHg, 95% CI: −5.68 to −2.84), 24 h ambulatory SBP (MD −2.63 mmHg), office DBP (MD −2.15 mmHg), 24-h ambulatory DBP (MD −1.27 mmHg), and daytime SBP and DBP (MD −3.29 and 2.97 mmHg), compared to the sham. The rate of severe complications was low in both groups (0%–2%). The heterogeneity was high among most indices, and CoE was very low for most outcomes. Conclusion: RDN significantly reduced several SBP and DBP outcomes versus sham without significantly increasing complications. This makes RDN a potentially effective alternative to medications in URH. © 2025 The Author(s). Clinical Cardiology published by Wiley Periodicals LLC.