TY - JOUR
T1 - Renal denervation for uncontrolled and resistant hypertension
T2 - Systematic review and network meta-analysis of randomized trials
AU - Silverwatch, Jonathan
AU - Marti, Kristen E.
AU - Phan, Mi T.
AU - Amin, Hinali
AU - Roman, Yuani M.
AU - Pasupuleti, Vinay
AU - Banach, Maciej
AU - Barboza, Joshuan J.
AU - Hernandez, Adrian V.
N1 - Publisher Copyright:
© 2021 by the authorsLicensee MDPI, Basel, Switzerland.
PY - 2021/2/16
Y1 - 2021/2/16
N2 - Comparative efficacy and safety of renal denervation (RDN) interventions for uncontrolled (UH) and resistant hypertension (RH) is unknown. We assessed the comparative efficacy and safety of existing RDN interventions for UH and RH. Six search engines were searched up to 1 May 2020. Primary outcomes were mean 24-h ambulatory and office systolic blood pressure (SBP). Secondary outcomes were mean 24-h ambulatory and office diastolic blood pressure (DBP), clinical outcomes, and serious adverse events. Frequentist random-effects network meta-analyses were used to evaluate effects of RDN interventions. Twenty randomized controlled trials (RCTs) (n = 2152) were included, 15 in RH (n = 1544) and five in UH (n = 608). Intervention arms included radiofrequency (RF) in main renal artery (MRA) (n = 10), RF in MRA and branches (n = 4), RF in MRA+ antihypertensive therapy (AHT) (n = 5), ultrasound (US) in MRA (n = 3), sham (n = 8), and AHT (n = 9). RF in MRA and branches ranked as the best treatment to reduce 24-h ambulatory, daytime, and nighttime SBP and DBP versus other interventions (p-scores: 0.83 to 0.97); significant blood pressure effects were found versus sham or AHT. RF in MRA+AHT was the best treatment to reduce office SBP and DBP (p-scores: 0.84 and 0.90, respectively). RF in MRA and branches was the most efficacious versus other interventions to reduce 24-h ambulatory SBP and DBP in UH or RH.
AB - Comparative efficacy and safety of renal denervation (RDN) interventions for uncontrolled (UH) and resistant hypertension (RH) is unknown. We assessed the comparative efficacy and safety of existing RDN interventions for UH and RH. Six search engines were searched up to 1 May 2020. Primary outcomes were mean 24-h ambulatory and office systolic blood pressure (SBP). Secondary outcomes were mean 24-h ambulatory and office diastolic blood pressure (DBP), clinical outcomes, and serious adverse events. Frequentist random-effects network meta-analyses were used to evaluate effects of RDN interventions. Twenty randomized controlled trials (RCTs) (n = 2152) were included, 15 in RH (n = 1544) and five in UH (n = 608). Intervention arms included radiofrequency (RF) in main renal artery (MRA) (n = 10), RF in MRA and branches (n = 4), RF in MRA+ antihypertensive therapy (AHT) (n = 5), ultrasound (US) in MRA (n = 3), sham (n = 8), and AHT (n = 9). RF in MRA and branches ranked as the best treatment to reduce 24-h ambulatory, daytime, and nighttime SBP and DBP versus other interventions (p-scores: 0.83 to 0.97); significant blood pressure effects were found versus sham or AHT. RF in MRA+AHT was the best treatment to reduce office SBP and DBP (p-scores: 0.84 and 0.90, respectively). RF in MRA and branches was the most efficacious versus other interventions to reduce 24-h ambulatory SBP and DBP in UH or RH.
KW - Network meta-analysis
KW - Renal denervation
KW - Resistant hypertension
KW - Uncontrolled hypertension
UR - http://www.scopus.com/inward/record.url?scp=85114073708&partnerID=8YFLogxK
U2 - 10.3390/jcm10040782
DO - 10.3390/jcm10040782
M3 - Artículo de revisión
C2 - 33669195
AN - SCOPUS:85114073708
SN - 2077-0383
VL - 10
SP - 1
EP - 14
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 4
M1 - 782
ER -