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28 February 2023
Effect of renal denervation for patients with isolated systolic hypertension: a systematic review and meta-analysis
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Renal denervation (RDN) is a promising treatment based on catheter intervention for patients with refractory hypertension. However, the effect in patients with isolated systolic hypertension (ISH) remains controversial. The aim of this meta-analysis was to determine the blood pressure lowing effect of RDN in patients with ISH compared with combined systolic/diastolic hypertension (CH) patients.
PubMed, Embase, Cochrane and ClinicalTrials.gov were searched for prospective clinical studies that included RDN. The outcomes of interest were the change of 24-hour ambulatory systolic blood pressure (SBP) from baseline. We used the fixed effects model to calculate weighted mean difference (WMD) with 95% confidence interval (CI).
Six trials were included, with 1405 participants, including 597 patients with ISH and 808 patients with CH. Mean follow-up was five months. The reduction of 24-hour ambulatory SBP was significantly greater for the CH patients than the ISH patients (WMD = 3.89, 95% CI: 2.32–5.45, P < 0.0001). RDN also showed a greater reduction in office SBP in the CH patients compared to the ISH patients (WMD = 10.24, 95% CI: 4.24–15.74, P = 0.0003). And the effect was independent of age, length of follow-up, and ablation device.
RDN provides superior blood pressure control in the CH patients compared with the ISH patients, and the CH patients may be the best suitable population for which RDN is indicated.
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Effect of renal denervation for patients with isolated systolic hypertension: a systematic review and meta-analysis
)
Abstract
Renal denervation (RDN) is a promising treatment based on catheter intervention for patients with refractory hypertension. However, the effect in patients with isolated systolic hypertension (ISH) remains controversial. The aim of this meta-analysis was to determine the blood pressure lowing effect of RDN in patients with ISH compared with combined systolic/diastolic hypertension (CH) patients.
PubMed, Embase, Cochrane and ClinicalTrials.gov were searched for prospective clinical studies that included RDN. The outcomes of interest were the change of 24-hour ambulatory systolic blood pressure (SBP) from baseline. We used the fixed effects model to calculate weighted mean difference (WMD) with 95% confidence interval (CI).
Six trials were included, with 1405 participants, including 597 patients with ISH and 808 patients with CH. Mean follow-up was five months. The reduction of 24-hour ambulatory SBP was significantly greater for the CH patients than the ISH patients (WMD = 3.89, 95% CI: 2.32–5.45, P < 0.0001). RDN also showed a greater reduction in office SBP in the CH patients compared to the ISH patients (WMD = 10.24, 95% CI: 4.24–15.74, P = 0.0003). And the effect was independent of age, length of follow-up, and ablation device.
RDN provides superior blood pressure control in the CH patients compared with the ISH patients, and the CH patients may be the best suitable population for which RDN is indicated.
References(34)
Mills KT, Stefanescu A, He J, et al. The global epidemiology of hypertension. Nat Rev Nephrol 2020; 16: 223−237.
Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation 2016; 134: 441−450.
Acelajado MC, Hughes ZH, Oparil S, et al. Treatment of resistant and refractory hypertension. Circ Res 2019; 124: 1061−1070.
Li L, Hu Z, Xiong Y, et al. Device-based sympathetic nerve regulation for cardiovascular diseases. Front Cardiovasc Med 2021; 8: 803984.
Kandzari DE, Böhm M, Mahfoud F, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet 2018; 391: 2346−2355.
Böhm M, Kario K, Kandzari DE, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet 2020; 395: 1444−1451.
Azizi M, Sanghvi K, Saxena M, et al. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial. Lancet 2021; 397: 2476−2486.
Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370: 1393−1401.
Mahfoud F, Schmieder RE, Azizi M, et al. Proceedings from the 2nd European Clinical Consensus Conference for device-based therapies for hypertension: state of the art and considerations for the future. Eur Heart J 2017; 38: 3272−3281.
Mahfoud F, Mancia G, Schmieder R, et al. Renal denervation in high-risk patients with hypertension. J Am Coll Cardiol 2020; 75: 2879−2888.
Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36: 1953−2041.
Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73: 712−716.
Follmann D, Elliott P, Suh I, et al. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 1992; 45: 769−773.
Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019; 10: ED000142.
Ewen S, Ukena C, Linz D, et al. Reduced effect of percutaneous renal denervation on blood pressure in patients with isolated systolic hypertension. Hypertension 2015; 65: 193−199.
Fengler K, Rommel KP, Hoellriegel R, et al. Pulse wave velocity predicts response to renal denervation in isolated systolic hypertension. J Am Heart Assoc 2017; 6: e005879.
Mahfoud F, Bakris G, Bhatt DL, et al. Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY registry. Eur Heart J 2017; 38: 93−100.
Chernin G, Szwarcfiter I, Scheinert D, et al. First-in-man experience with a novel catheter-based renal denervation system of ultrasonic ablation in patients with resistant hypertension. J Vasc Interv Radiol 2018; 29: 1158−1166.
Fengler K, Rommel KP, Lapusca R, et al. Renal denervation in isolated systolic hypertension using different catheter techniques and technologies. Hypertension 2019; 74: 341−348.
Mahfoud F, Townsend RR, Kandzari DE, et al. Changes in plasma renin activity after renal artery sympathetic denervation. J Am Coll Cardiol 2021; 77: 2909−2919.
Li L, Xiong Y, Hu Z, et al. Effect of renal denervation for the management of heart rate in patients with hypertension: a systematic review and meta-analysis. Front Cardiovasc Med 2022; 8: 810321.
Tsai TY, Cheng HM, Chuang SY, et al. Isolated systolic hypertension in Asia. J Clin Hypertens (Greenwich) 2021; 23: 467−474.
Flint AC, Conell C, Ren X, et al. Effect of systolic and diastolic blood pressure on cardiovascular outcomes. N Engl J Med 2019; 381: 243−251.
Bavishi C, Goel S, Messerli FH, et al. Isolated systolic hypertension: an update after SPRINT. Am J Med 2016; 129: 1251−1258.
Brandt MC, Reda S, Mahfoud F, et al. Effects of renal sympathetic denervation on arterial stiffness and central hemodynamics in patients with resistant hypertension. J Am Coll Cardiol 2012; 60: 1956−1965.
Schmieder RE, Mahfoud F, Mancia G, et al. European Society of Hypertension position paper on renal denervation 2021. J Hypertens 2021; 39: 1733−1741.
Mulder J, Hökfelt T, Knuepfer MM, et al. Renal sensory and sympathetic nerves reinnervate the kidney in a similar time-dependent fashion after renal denervation in rats. Am J Physiol Regul Integr Comp Physiol 2013; 304: R675−R682.
Mahfoud F, Kandzari DE, Kario K, et al. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial. Lancet 2022; 399: 1401−1410.
Sakakura K, Roth A, Ladich E, et al. Controlled circumferential renal sympathetic denervation with preservation of the renal arterial wall using intraluminal ultrasound: a next-generation approach for treating sympathetic overactivity. EuroIntervention 2015; 10: 1230−1238.
Al Raisi SI, Pouliopoulos J, Barry MT, et al. Evaluation of lesion and thermodynamic characteristics of Symplicity and EnligHTN renal denervation systems in a phantom renal artery model. EuroIntervention 2014; 10: 277−284.
Fengler K, Rommel KP, Blazek S, et al. A three-arm randomized trial of different renal denervation devices and techniques in patients with resistant hypertension (RADIOSOUND-HTN). Circulation 2019; 139: 590−600.
Cheng Y, Liu H, Tian Z, et al. Comparison of ablation characteristics of three different radiofrequency applicators in renal sympathetic denervation. Int J Hyperthermia 2021; 38: 1251−1262.
García-Touchard A, Maranillo E, Mompeo B, et al. Microdissection of the human renal nervous system: implications for performing renal denervation procedures. Hypertension 2020; 76: 1240−1246.
Fengler K, Ewen S, Höllriegel R, et al. Blood pressure response to main renal artery and combined main renal artery plus branch renal denervation in patients with resistant hypertension. J Am Heart Assoc 2017; 6: e006196.
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Acknowledgements
This study was supported by the National Natural Science Foundation of China (No.81970285). All authors had no conflicts of interest to disclose.
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