The following are key points to remember from a systematic review and meta-analysis on the effects of catheter-based renal denervation in patients with hypertension (HTN):

1. In a meta-analysis of 10 sham-controlled trials that included 2,478 patients, renal denervation decreased 24-hour systolic blood pressure (BP) by 4.4 mm Hg and office systolic pressure by 6.6 mm Hg, both of which were statistically significant.
2. This BP drop was seen in patients with both medication treated and untreated HTN.
3. Renal denervation appeared to be safe, with no notable risk of renal impairment or vascular injury.
4. All methods of denervation (alcohol mediated, ultrasound, or radiofrequency) were effective.
5. The BP drop was similar to that generally seen in about one-half medication. Clinicians must be thoughtful in determining whether renal denervation is the best way to achieve this BP drop, particularly in obese patients in whom glucagon-like peptide-1 inhibition may also give a similar antihypertensive effect.
6. Future studies may identify subgroups of patients, such as younger patients, for whom renal denervation may potentially be more effective than in older patients.
7. This study had maximum follow-up of 6 months. It is unknown if reinnervation will occur if patients were followed for a longer period of time.
8. More experience is necessary to establish where renal denervation will be of best use in a clinician’s armamentarium. Patients are often intolerant of medications, hesitant to take medications, and can also have HTN resistant to even the best medical regimen. Similarly, a patient’s antihypertensive regimen can frequently be adjusted by specialists trained specifically in HTN management in a way that can often yield considerable improvement in BP.
9. Patients with secondary causes of HTN were excluded from these trials.

Clinical Topics: Prevention, Hypertension, Invasive Cardiovascular Angiography and Intervention

Keywords: Antihypertensive Agents, Blood Pressure, Denervation, Hypertension

< Back to Listings