title: Meta-analysis of the effect of renal denervation on blood pressure and pulse pressure in patients with resistant systemic hypertension.
abstract: Data comparing the effect of renal denervation (RD) with those of maximal medical therapy (MMT) have shown conflicting results. Also, effect of RD on pulse pressure (PP) has not been evaluated. The aim of this meta-analysis was to compare the effect of RD with that of MMT on blood pressure (BP) and PP at 6-month follow-up in patients with resistant hypertension. Randomized controlled trials and nonrandomized controlled trials reporting systolic BP, diastolic BP, and PP results in RD and MMT groups at 6-month follow-up in patients with resistant hypertension were systematically reviewed, and eligible citations were pooled using a random-effects model. Five studies (3 randomized controlled trials, 2 nonrandomized controlled trials, n = 800) met the inclusion criteria. In the pooled analysis, RD was associated with a significant decrease in systolic BP (weighted mean difference -19.4 mm Hg, 95% confidence interval -32.8 to -5.9, p = 0.005), diastolic BP (weighted mean difference -6.4 mm Hg, 95% confidence interval -10.7 to -2.0 mm Hg, p = 0.004), and PP (weighted mean difference -12.7 mm Hg, 95% confidence interval -22.3 to -3.1 mm Hg, p = 0.009) compared with MMT at 6-month follow-up. Sensitivity analysis limited to randomized controlled trials showed a borderline significant difference in lowering systolic BP, a significant difference in lowering diastolic BP, and a nonsignificant difference in lowering PP when RD was compared with MMT. In conclusion, this meta-analysis shows that RD is superior to MMT in lowering BP, but heterogeneity among study populations in this pooled sample is high, and further data are needed to better compare these treatment strategies.
authors.affiliation: The Commonwealth Medical College and The Wright Center for Graduate Medical Education, Scranton, Pennsylvania. Electronic address: pancholys@gmail.com.
authors.forename: Samir B
authors.initials: SB
authors.lastname: Pancholy
authors.affiliation: The Commonwealth Medical College and The Wright Center for Graduate Medical Education, Scranton, Pennsylvania.
authors.forename: Ghanshyam Palamaner Subash
authors.initials: GP
authors.lastname: Shantha
authors.affiliation: Apex Heart Institute and Seth N.H.L. Municipal Medical College, Ahmedabad, India.
authors.forename: Tejas M
authors.initials: TM
authors.lastname: Patel
authors.affiliation: Ohio State University, Columbus, Ohio.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.affiliation: Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome