A Meta-analysis Of Effectiveness And Safety Of Renal Denervation In Resistant Hypertension

Background:Early partial observational studies have shown that renal denervation therapy(RDN)can significantly reduce blood pressure in patients with resistant hypertension(RH),but because of the results of the 2014 Symplicity HTN-3 study,almost all researches about RDN had been suspended.Therefore,this paper conducted a meta-analysis of the short-term clinical results and safety of RH in the treatment of RDN,which provides a certain reference for clinical decision-making.Methods:Using the computer retrieves databases such as Pubmed,EMBASE,Web of Science,CBM,CNKI and Wanfang Data Knowledge Service Platform.Searching up to December 2018 to collect the English and Chinnese literatures.Manually search related magazines,conference papers,and unpublished grey literature.According to the Cochrane systematic review method,the Chinese and English randomized controlled trials(RCTs)for RDN of RH were screened,and the data extraction and quality evaluation of the included literature were carried out.The Meta-analysis was performed using RevMan 5.3 software.Results:Finally,9 RCTs were included,a total of 1195 patients.The results of meta-analysis showed that 3-6 months after surgery,the systolic and diastolic blood pressures of the RDN group and the control group reduced,and the differences between two groups became statistically significant(MD=-7.44 mmHg,95%CI:-12.88～-2.00,Z=2.68,P=0.007;MD=-3.81mmHg,95%CI:-6.26～-1.37,Z=3.05,P=0.002).The systolic and diastolic blood pressures of the 24-hour ambulatory blood pressure monitoring(ABPM)in the RDN group and the control group were also reduced,and the differences between two groups were statistically significant(MD=-4.57 mmHg,95%CI:-6.20～-2.93,Z=5.48,P<0.01;MD=-2.38 mmHg,95%CI:-3.75 to-1.01,Z=3.40,P<0.01).After 3-6 months,there was no significant difference in estimate glomerular filtration rate(eGFR)between the RDN group and the control group(MD=-0.08ml/min/1.73m2,95%CI:-1.78-1.63,Z=0.09,P=0.93).There are few complications after surgery and the operation is safe.Conclusion:For patients with RH,RDN can not only reducing the blood pressure in the office,but also reducing the 24-hour ambulatory blood pressure,and is safe.High-quality large-scale multicenter shamed randomized controlled trials and long-term postoperative clinical outcomes are the focus of future research.