Renal Denervation for the Treatment of Resistant Hypertension: A Systematic Review of Sham-Controlled Trials

Abstract

Introduction: Resistant hypertension is associated with poor clinical outcomes. Catheter-based renal denervation (RDN) is an invasive procedure aimed at reducing sympathetic nerve activity to lower blood pressure. This review evaluates its efficacy based on recent sham-controlled trials.

Methods: We conducted a search of MEDLINE and CENTRAL for sham-controlled RCTs of radiofrequency or ultrasound-based RDN. The primary outcomes were the changes in 24-hour ambulatory and office systolic blood pressure (SBP).

Results: The meta-analysis of six recent-generation, sham-controlled trials showed that RDN resulted in a statistically significant and clinically meaningful reduction in both ambulatory and office SBP compared to the sham procedure. The procedure had a favorable safety profile.

Discussion: After initial setbacks, contemporary RDN technologies and trial designs have demonstrated a clear, albeit modest, blood pressure-lowering effect. RDN may be a valuable adjunct to medication for patients with uncontrolled hypertension.

Conclusion: Renal denervation is an effective procedure for lowering blood pressure in patients with resistant hypertension.