Assessing the efficacy of renal denervation in patients with resistant arterial hypertension : Systematic review and meta-analysis.

Autor: Gonçalves OR; Federal University of Piauí, Teresina, Piauí, Brazil., Kelly FA; Department of Hypertension, Dante Pazzanese Cardiological Institute, São Paulo, Brazil., Maia JG; Department of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil., de Oliveira Macena Lôbo A; Department of Medicine, Federal University of Acre, Rio Branco, Acre, Brazil., Tsuchiya Sano VK; Department of Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil., Cavalcanti Souza ME; Department of Medicine, University of Pernambuco, Recife, Pernambuco, Brazil., de Moraes FCA; Department of Medicine, Federal University of Pará, Belém, Pará, Brazil., Farid N; Department of Medicine, Mohiuddin Islamic Medical College, Mandi-bhauddin, Punjab, Pakistan., Bispo da Silva Júnior A; Federal University of Piauí, Teresina, Piauí, Brazil. arlindobispo2003@gmail.com., da Silva AA; Federal University of Piauí, Teresina, Piauí, Brazil.
Jazyk: angličtina
Zdroj: Herz [Herz] 2024 Sep 10. Date of Electronic Publication: 2024 Sep 10.
DOI: 10.1007/s00059-024-05268-9
Abstrakt: Background: Renal denervation (RDN) is an innovative procedure designed to regulate the renal sympathetic nervous system for the control of arterial hypertension (HTN). RDN has emerged as an alternative for patients with resistant HTN. However, the clinical efficacy of RDN remains incompletely elucidated.
Methods: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing the use of RDN with sham procedure or pharmacological treatment in patients with resistant HTN. Statistical analyses were performed using R Studio 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was examined with the Cochran Q test I 2 statistics. Mean difference (MD) with 95% confidence interval (CI) were pooled across trials. P values of <0.05 were considered statistically significant. The primary outcomes of interest were changes from baseline in systolic blood pressure (SBP), diastolic blood pressure (DBP), and serum creatinine.
Results: Twenty-one RCTs comprising 3345 patients were included in this meta-analysis, whereby 2004 (59.91%) received renal denervation and 1341 (40.09%) received pharmacological treatment or sham procedure. Follow-up ranged from 2 to 48 months. Compared to control group, RDN significantly reduced SBP (MD -3.53 mm Hg; 95% CI -5.94 to -1.12; p = 0.004; I 2  = 74%) and DBP (MD -1.48 mm Hg; 95% CI -2.56 to -0.40; p = 0.007; I 2  = 51%). Regarding serum creatinine (MD -2.51; 95% CI -7.90 to 2.87; p = 0.36; I 2  = 40%), there was no significant difference between RDN and control groups.
Conclusion: In this meta-analysis of RCTs of patients with resistant HTN, RDN was associated with a reduction in SBP and DBP compared to sham procedure or pharmacological treatment.
(© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
Databáze: MEDLINE
Externí odkaz: