title: Effectiveness of renal denervation therapy for resistant hypertension: a systematic review and meta-analysis.
abstract: OBJECTIVE
  This study sought to determine the current effectiveness and safety of sympathetic renal denervation (RDN) for resistant hypertension.
  
  
  BACKGROUND
  RDN is a novel approach that has been evaluated in multiple small studies.
  
  
  METHODS
  We performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with resistant hypertension. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models.
  
  
  RESULTS
  We identified 2 randomized controlled trials, 1 observational study with a control group, and 9 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic blood pressure (BP) at 6 months of -28.9 mm Hg (95% confidence interval [CI]: -37.2 to -20.6 mm Hg) and -11.0 mm Hg (95% CI: -16.4 to -5.7 mm Hg), respectively, compared with medically treated patients (for both, p < 0.0001). In uncontrolled studies, there was a reduction in mean systolic and diastolic BP at 6 months of -25.0 mm Hg (95% CI: -29.9 to -20.1 mm Hg) and -10.0 mm Hg (95% CI: -12.5 to -7.5 mm Hg), respectively, compared with pre-RDN values (for both, p < 0.00001). There was no difference in the effect of RDN according to the 5 catheters employed. Reported procedural complications included 1 renal artery dissection and 4 femoral pseudoaneurysms.
  
  
  CONCLUSIONS
  RDN resulted in a substantial reduction in mean BP at 6 months in patients with resistant hypertension. The decrease in BP was similar irrespective of study design and type of catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN.
authors: Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada.
authors: Mark I
authors: MI
authors: Davis
authors: Division of Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada.
authors: Kristian B
authors: KB
authors: Filion
authors: Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada.
authors: David
authors: D
authors: Zhang
authors: Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada.
authors: Mark J
authors: MJ
authors: Eisenberg
authors: Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada.
authors: Jonathan
authors: J
authors: Afilalo
authors: Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.
authors: Ernesto L
authors: EL
authors: Schiffrin
authors: Department of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada. Electronic address: djoyal@jgh.mcgill.ca.
authors: Dominique
authors: D
authors: Joyal
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation* / Q000502:physiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013562:Sympathectomy / Q000379:methods; D016896:Treatment Outcome