Long-term impacts of renal denervation on office and 24-hour ambulatory blood pressure: a systematic review and meta-analysis of sham-controlled studies
R Lashkari, R Eshraghi, A Ibrahim, A Fatehi Hassanabad, P Ebrahimi, A L B E R T O Palazzuoli, K Keramida, D Hakim, A Bahrami, S Yazdani, A Riyahi, H Soleimani, K hosseiniAbstract
Background
Renal denervation has re-emerged as a device-based therapy for hypertension, yet durability of effect versus sham over long follow-up remains debated. We synthesized sham-controlled evidence using each trial’s longest available follow-up.
Methods
We systematically searched PubMed, Scopus, Web of Science, and Google Scholar from inception to 1 June 2025. Eligible studies were randomized, sham-controlled trials reporting change from baseline in office blood pressure and/or 24-hour ambulatory blood pressure. The primary outcomes were mean differences in office systolic and diastolic blood pressure and 24-hour ambulatory systolic and diastolic blood pressure at the longest follow-up. Random-effects inverse-variance meta-analyses were performed. Heterogeneity was quantified with I² and τ².
Results
Across 18 sham-controlled trials, using each study’s longest follow-up, renal denervation consistently lowered blood pressure versus sham. On average, office systolic pressure fell by 15.54 mmHg 95%CI (−18.56 to −12.52) and office diastolic by 8.19 mmHg 95 percent confidence interval (−9.89 to −6.50). The 24-hour ambulatory readings showed smaller but still meaningful drops: systolic −9.21 mmHg 95%CI (−11.19 to −7.23) and diastolic −5.39 mmHg 95% CI (−6.50 to −4.28). While the amount of benefit varied between studies I² about ninety seven percent across outcomes, the direction of effect was uniformly in favor of renal denervation at short and longer follow-up windows, indicating a durable reduction in both office and ambulatory blood pressure.
Conclusions
Using the longest available follow-up from sham-controlled randomized trials, renal denervation is associated with durable reductions in both office and 24-hour ambulatory blood pressure. Despite substantial heterogeneity, the pooled effects suggest a clinically meaningful benefit that persists beyond the short term. Future work should standardize outcome reporting, explore sources of heterogeneity, and determine which patient subgroups derive the greatest long-term benefit.Renal Denervation1Renal Denervation 2