Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia.
Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California.
Catheter Cardiovasc Interv. 2021 Mar;97(4):E438-E445. doi: 10.1002/ccd.29384. Epub 2020 Nov 12.
Sympathetic nervous system plays a central role in the development and persistence of essential hypertension. In recent years renal sympathetic denervation (RSD) has emerged as a promising option for the treatment of patients with hypertension.
We conducted a literature search of PubMed, EMBASE, Cochrane library and Clinicaltrials.gov from inception through April 20, 2020. Outcomes of interest were change in 24-hour ambulatory systolic (ASBP) or diastolic blood pressure (ADBP) and change in office systolic (OSBP) or diastolic blood pressure (ODBP). We pooled data from randomized controlled trials (RCTS) comparing RSD to sham procedures in the management of hypertension using the random effect model.
A total of 1,363 patients from eight studies were included in the current meta-analysis. The mean age of the included patients was 56 ± 2.6 years, 29% were women and the median duration of maximum follow up was 6-month (range 3-12 month). There was more reduction favoring RSD in ASBP (Weighted mean difference [WMD] -3.55; 95% CI -4.91 - -2.19, p < .001, I = 0%), ADBP (WMD -1.87; 95% CI -3.07 - -0.66, p = .002, I = 43%), OSBP (WMD -5.5; 95% CI -7.59 - -3.40, p < .001, I = 7%) and ODBP (WMD -3.20; 95% CI -4.47 - -1.94, p < .001, I = 14%).
The use of RSD for the management of hypertension resulted in effective reduction in the ambulatory and office blood pressure compared to sham procedure. Adequately powered RCTs of RSD are needed to confirm safety, reproducibility and assess the impact on clinical outcomes.
交感神经系统在原发性高血压的发生和持续中起着核心作用。近年来，肾去交感神经术（RSD）已成为治疗高血压患者的一种有前途的选择。
我们对 PubMed、EMBASE、Cochrane 图书馆和 Clinicaltrials.gov 进行了文献检索，检索时间从建库至 2020 年 4 月 20 日。主要结局指标为 24 小时动态收缩压（ASBP）或舒张压（ADBP）的变化和诊室收缩压（OSBP）或舒张压（ODBP）的变化。我们使用随机效应模型，对比较 RSD 与假手术治疗高血压的随机对照试验（RCT）的数据进行了汇总。
共有 8 项研究的 1363 名患者纳入本次荟萃分析。纳入患者的平均年龄为 56±2.6 岁，29%为女性，最长随访时间中位数为 6 个月（范围 3-12 个月）。RSD 更有利于 ASBP（加权均数差 [WMD] -3.55；95%CI -4.91 - -2.19，p<.001，I=0%）、ADBP（WMD -1.87；95%CI -3.07 - -0.66，p=0.002，I=43%）、OSBP（WMD -5.5；95%CI -7.59 - -3.40，p<.001，I=7%）和 ODBP（WMD -3.20；95%CI -4.47 - -1.94，p<.001，I=14%）的降低。
与假手术相比，RSD 用于治疗高血压可有效降低动态和诊室血压。需要进行充分的 RSD 随机对照试验来确认安全性、可重复性并评估对临床结局的影响。
