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The efficacy of renal denervation (RDN) at reducing blood pressure (BP) in patients with treatment resistant hypertension (TRH) is controversial. The effect of RDN on other measures of overall sympathetic activity, such as the heart rate, is not well defined.
We conducted a PUBMED, EMBASE, CENTRAL search for studies evaluating RDN for TRH and reporting data on heart rate. Outcome of interest was change in heart rate from baseline for the RDN and the control groups. Results were pooled using the weighted mean difference (WMD) method of Cohen.
Twenty-eight studies (including five randomized controlled trials) with 2025 patients fulfilled our inclusion criteria. The mean baseline heart rate was 68.2 ± 11.8 beats per minute (bpm) in the RDN group and 68.7 ± 12.6 bpm in the control group. RDN was associated with a 3.25 bpm (95% CI 2.54-3.96 bpm) reduction in heart rate from baseline. The results were consistently observed both from non-randomized studies (WMD 3.03 bpm, 95% CI 2.20-3.85 bpm) and randomized studies (WMD 3.91 bpm, 95% CI 2.51-5.31). Meta-regression analysis showed that the magnitude of heart rate reduction with RDN was proportional to the baseline heart rate. There was no significant change in heart rate in the control group (WMD 1.27 bpm, 95% CI -0.76 to 3.30 bpm).
The results of this study indicate a modest effect of RDN on lowering resting heart rate which is greater in patients with higher baseline heart rate.
ENDOVASCULAR: Hypertension Therapies and Renal Denervation