Long-term effects of renal denervation on hypertension management: a systematic review and meta-analysis
K Kyriakoulis, S Soulaidopoulos, D Konstantinidis, K Dimitriadis, F Tatakis, M Stathoulopoulou, K Platanias, K Papadomarkaki, P Iliakis, A Makris, A Kasiakogias, A Kordalis, V Papademetriou, K TsioufisAbstract
Background/Introduction
Renal denervation (RDN) has been approved in Europe and the US and is recommended by the ESH, ACC/AHA and ESC hypertension guidelines as a therapeutic option for patients with resistant or uncontrolled hypertension.
Purpose
The aim of this study was to perform a systematic review and meta-analysis of current evidence to evaluate the long-term durability and safety of the procedure.
Methods
A systematic literature search was conducted to identify relevant studies reporting long-term outcomes of RDN beyond 3 years of follow-up. Data of interest (baseline characteristics, BP data, eGFR) were extracted and tabulated in order to be used in the context of a meta-analysis.
Results
Eight studies fulfilled the inclusion criteria and were included in the systematic review and meta-analysis. Most studies were conducted in Europe, one in Brazil, one in China and one in Australia. Follow-up duration ranged from 5 to 10 years. Meta-analysis of 8 studies (N=384, weighted mean age 61 years, 25% females) indicated a pooled follow-up minus baseline systolic and diastolic 24h ABP mean difference of -15.7 mmHg (-18.4, -13.0) and -9.2 mmHg (-10.5, -7.9), respectively, over a period of 8.7 years. Meta-analysis of 5 studies (N=187, weighted mean age 64 years, 34% females) indicated a pooled follow-up minus baseline eGFR mean difference of -8.9 ml/min/1.73 m2 (-11.1, -6.7) over a period of 8.5 years.
Conclusion(s)
The RDN procedure has a favorable efficacy and safety profile, with minimal peri-procedural and long-term vascular complications and no clinically meaningful effects on renal function. The lasting benefits of the intervention enhance its appeal as a supplementary approach for the management of hypertension.Figure