Yao Yuanqing, Zhang Dengqing, Qian Jun, Deng Shimin, Huang Yuwen, Huang Jing
a Department of Cardiology , The Second Affiliated Hospital of Chongqing Medical University , Chongqing , China.
b Department of Cardiolgy , The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China.
Clin Exp Hypertens. 2016;38(3):278-86. doi: 10.3109/10641963.2015.1089881. Epub 2016 Mar 28.
This meta-analysis was conducted to evaluate the efficiency of renal denervation (RDN) on resistant hypertension.
PubMed, EMBASE, and the Cochrane Central database were searched for eligible randomized controlled clinical trials (RCTs). Changes from the baseline of the office blood pressure and the 24-h ambulatory blood pressure were extracted.
Nine RCTs were included. RDN reduced the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) by -8.23 mm Hg (95%CI: -16.86, 0.39) and -3.77 mm Hg (95%CI: -7.21, -0.32), respectively, compared with the control. In the population with a baseline SBP more than 170 mm Hg, the RDN reduced SBP by -17.77 mm Hg (95%CI: -33.73, -1.82) and DBP by -7.51 mm Hg (95%CI: -12.58, -2.44). In the subgroup with no medication adjustment, the RDN reduced SBP by -15.56 mm Hg (95%CI: -26.33, -4.80) and DBP by -6.89 mm Hg (95%CI: -9.99, -3.79). The proportion of patients with SBP decrease of 10 mm Hg or more and the controlled office BP were not different between two groups. RDN reduced 24-h mean SBP and DBP by -3.34 mm Hg (95%CI: -5.30, -1.38) and -1.56 mm Hg (95%CI: -2.71, -0.41), respectively. The SBPs in the subgroups with higher baseline SBP and with no medication adjustment were significantly decreased after the HTN-3 was omitted.
Radiofrequency RDN in a randomized manner did not have superiority compared with medical treatment at 6-month follow-up in general population. Current evidence provides insufficient evidence to support the use of such RDN strategy in the treatment of resistant hypertension. The result could not be used to extrapolate other strategies' effect.
本荟萃分析旨在评估肾去神经支配术（RDN）治疗顽固性高血压的疗效。
检索PubMed、EMBASE和Cochrane中心数据库，查找符合条件的随机对照临床试验（RCT）。提取诊室血压和24小时动态血压相对于基线的变化。
纳入9项RCT。与对照组相比，RDN使平均收缩压（SBP）和舒张压（DBP）分别降低-8.23 mmHg（95%CI：-16.86，0.39）和-3.77 mmHg（95%CI：-7.21，-0.32）。在基线SBP超过170 mmHg的人群中，RDN使SBP降低-17.77 mmHg（95%CI：-33.73，-1.82），DBP降低-7.51 mmHg（95%CI：-12.58，-2.44）。在未调整药物治疗的亚组中，RDN使SBP降低-15.56 mmHg（95%CI：-26.33，-4.80），DBP降低-6.89 mmHg（95%CI：-9.99，-3.79）。两组间SBP降低10 mmHg或更多的患者比例和诊室血压得到控制的患者比例无差异。RDN使24小时平均SBP和DBP分别降低-3.34 mmHg（95%CI：-5.30，-1.38）和-1.56 mmHg（95%CI：-2.71，-0.41）。排除HTN-3研究后，基线SBP较高和未调整药物治疗的亚组中的SBP显著降低。
在一般人群中，随访6个月时，随机射频RDN与药物治疗相比无优势。目前的证据不足以支持使用这种RDN策略治疗顽固性高血压。该结果不能外推至其他策略的效果。
