Randomised placebo-controlled trials show consistently that renal denervation provides significant reduction in ambulatory and office blood pressure, the findings of a systematic review and meta-analysis suggest.
Findings of the paper, authored by Yousif Ahmad (Yale School of Medicine, Yale University, New Haven) and colleagues, were published in JACC: Cardiovascular Interventions and presented during an oral abstract session at the Transcatheter Cardiovascular Therapeutics annual meeting (TCT 2021, 4–6 November, Orlando USA and virtual).
In their paper, Ahmad and colleagues note that renal denervation has undergone several blinded placebo-controlled trials, covering the spectrum from patients with drug-resistant hypertension to those not yet taking antihypertensive medication.
The authors performed an updated meta-analysis of randomised placebo-controlled trials of renal denervation and specifically compared the effect of renal denervation in patients taking medications and in those not taking medications. This included latest evidence from the RADIANCE-HTN TRIO trial, presented on the same day at TCT 2021 in a late-breaking trial session.
The study’s primary efficacy outcome was the change in ambulatory systolic blood pressure beyond the effect of the placebo procedure, and analysis was stratified by whether there was background antihypertensive medication use.
Ahmad and colleagues report that there were seven eligible trials, totalling 1,368 patients.
Outlining the results, the study team notes that renal denervation significantly reduced ambulatory systolic (mean difference −3.61mmHg; 95% confidence interval [CI]: -4.89 to -2.33mmHg; p<0.0001), ambulatory diastolic (-1.85mmHg; 95% CI: -2.78 to -0.92mmHg; p<0.0001), office systolic (-5.86mmHg; 95% CI: -7.77 to -3.94mmHg; p<0.0001), and office diastolic (-3.63 mm Hg; 95% CI: -4.77 to -2.50; P < 0.0001) blood pressure.
There was no evidence that the use of concomitant antihypertensive medication had a significant impact on the effect of denervation on any of these endpoints (p-interaction=NS for each comparison).
Ahmad and colleagues conclude that the randomised placebo-controlled trials show “consistently” that renal denervation provides significant reduction in ambulatory and office blood pressure.
“Although the magnitude of benefit, about 4/2mmHg, is modest, it is similar between patients on background antihypertensive medications and those who are not. Denervation could therefore be a useful strategy at various points for patients who are not willing to add antihypertensive agents,” the study’s authors note. “Whether the effect changes with time is currently unknown.”