Mark I Davis1, Kristian B Filion2, David Zhang1, Mark J Eisenberg3, Jonathan Afilalo3, Ernesto L Schiffrin4, Dominique Joyal5. 1. Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada. 2. Division of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada. 3. Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada. 4. Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada. 5. Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada. Electronic address: djoyal@jgh.mcgill.ca.
Abstract
OBJECTIVES: This study sought to determine the current effectiveness and safety of sympathetic renal denervation (RDN) for resistant hypertension. BACKGROUND: RDN is a novel approach that has been evaluated in multiple small studies. METHODS: We performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with resistant hypertension. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models. RESULTS: We identified 2 randomized controlled trials, 1 observational study with a control group, and 9 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic blood pressure (BP) at 6 months of -28.9 mm Hg (95% confidence interval [CI]: -37.2 to -20.6 mm Hg) and -11.0 mm Hg (95% CI: -16.4 to -5.7 mm Hg), respectively, compared with 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 mm Hg (95% CI: -29.9 to -20.1 mm Hg) and -10.0 mm Hg (95% CI: -12.5 to -7.5 mm Hg), respectively, compared with pre-RDN values (for both, p < 0.00001). There was no difference in the effect of RDN according to the 5 catheters employed. Reported procedural complications included 1 renal artery dissection and 4 femoral pseudoaneurysms. CONCLUSIONS: RDN resulted in a substantial reduction in mean BP at 6 months in patients with resistant hypertension. The decrease in BP was similar irrespective of study design and type of catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN.
OBJECTIVES: This study sought to determine the current effectiveness and safety of sympathetic renal denervation (RDN) for resistant hypertension. BACKGROUND: RDN is a novel approach that has been evaluated in multiple small studies. METHODS: We performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with resistant hypertension. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models. RESULTS: We identified 2 randomized controlled trials, 1 observational study with a control group, and 9 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic blood pressure (BP) at 6 months of -28.9 mm Hg (95% confidence interval [CI]: -37.2 to -20.6 mm Hg) and -11.0 mm Hg (95% CI: -16.4 to -5.7 mm Hg), respectively, compared with 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 mm Hg (95% CI: -29.9 to -20.1 mm Hg) and -10.0 mm Hg (95% CI: -12.5 to -7.5 mm Hg), respectively, compared with pre-RDN values (for both, p < 0.00001). There was no difference in the effect of RDN according to the 5 catheters employed. Reported procedural complications included 1 renal artery dissection and 4 femoral pseudoaneurysms. CONCLUSIONS: RDN resulted in a substantial reduction in mean BP at 6 months in patients with resistant hypertension. The decrease in BP was similar irrespective of study design and type of catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN.
Authors: Christopher T Banek; Madeline M Gauthier; Daniel C Baumann; Dusty Van Helden; Ninitha Asirvatham-Jeyaraj; Angela Panoskaltsis-Mortari; Gregory D Fink; John W Osborn Journal: Am J Physiol Regul Integr Comp Physiol Date: 2018-03-07 Impact factor: 3.619
Authors: Christopher T Banek; Mark M Knuepfer; Jason D Foss; Jessica K Fiege; Ninitha Asirvatham-Jeyaraj; Dusty Van Helden; Yoji Shimizu; John W Osborn Journal: Hypertension Date: 2016-10-03 Impact factor: 10.190