Author + information
- Mark Isaac Davis,
- Kristian B. Filion,
- David Zhang,
- Mark Eisenberg,
- Jonathan Afilalo and
- Dominique Joyal
Limited pharmacological options exist for patients with resistant hypertension (RH). Sympathetic renal denervation therapy (RDN) is a novel approach which has been evaluated in multiple small studies. We sought to determine the current effectiveness and safety of RDN on RH.
We performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with RH. Data was extracted in duplicate and analyzed by comparing the mean achieved difference in blood pressure (BP) with RDN using random-effects meta-analytic models. Studies were stratified according to controlled vs. uncontrolled design.
We identified 2 randomized controlled trials (N=133), 1 observational study with a control group (N=50) and 9 uncontrolled observational studies (N=396) evaluating the effect of RDN on RH. These studies included 579 patients followed for a weighted average follow-up of 6.7 months (range 1 to 24 months). Five different RDN catheters were used among the 12 studies. In controlled studies, there was a reduction in mean systolic and diastolic BP at 6 months of −28.9 (95% CI −37.2, −20.6) and −11.0 (95% CI −16.4, −5.7) mmHg, respectively, compared to medically treated patients (for both, p<0.0001). In uncontrolled studies, there was a reduction in mean systolic and diastolic BP at 6 months of −25.0 (95% CI −29.9, −20.1) and −10.0 (95% CI −12.5, −7.5) mmHg, respectively, compared to pre-RDN values (for both, p<0.00001). There was no significant difference in the effect of RDN according to the catheter employed. Overall, the non-responder rate was 13.4% (range 0-45%). Reported procedural complications included 1 renal artery dissection and 4 pseudoaneurysms at the site of arterial puncture.
RDN results in a substantial reduction in mean BP at 6 months in patients with RH. The magnitude of decrease in BP was similar irrespective of controlled vs. uncontrolled study design and catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Renal Denervation: Coming of Age
Abstract Category: 25. Prevention: Hypertension
Presentation Number: 1148-23
- 2013 American College of Cardiology Foundation