May 2024
Long-term efficacy and safety of renal denervation for blood pressure reduction

A meta-analysis shows sustained blood pressure reduction after RDN, but with ongoing use of multiple antihypertensive medications.

Renal denervation (RDN) has been developed as a novel treatment for hypertension. Previous studies of RDN, typically using concomitant anti­hypertensive medications, have found modest blood pressure reduction; however, most studies have been of short duration. In order to understand long­-term effects of RDN, investigators pooled mean results from four observational studies with as long as 10 years of follow up (N=264) and two randomised, sham-controlled trials with three years of follow up (257 patients received RDN, 75 received sham procedure).

RDN was associated with clinically significant blood pressure reductions in both observational and randomised, sham-controlled studies. Using ambulatory blood pressure monitoring, in the four observational studies (average follow up, eight years), the average systolic blood pressure reduction was −14.8±3.4 mmHg. In the two randomised, controlled trials, the average sham-adjusted systolic blood pressure reduction at three years post­ procedure was −12.7 ± 4.5 mmHg. Anti­hypertensive drug burden did not change significantly between baseline and follow up assessments. RDN was not associated with an adverse effect on renal function beyond what would be expected with ageing.

Comment: The data on RDN continue to show clinically significant blood pressure reduction, and this analysis offers com­forting data on long-­term efficacy and safety. It is important to note that almost all patients still require substantial anti­hypertensive medication use to achieve blood pressure control. In cases of resistant hypertension, I will think about using RDN as adjunctive therapy.

Karol E. Watson, MD, PhD, FACC, John C. Mazziotta, MD, PhD, Term Endowed Chair and Professor of Medicine/Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, USA.

Sesa-Ashton G, et al. Long-term blood pressure reductions following catheter-based renal denervation: a systematic review and meta-analysis. Hypertension 2024 Mar 20; e-pub ( HYPERTENSIONAHA.123.22314).

This summary is taken from the following Journal Watch titles: Cardiology, General Medicine.