Li Le, Xiong Yu-Long, Tu Bin, Liu Shang-Yu, Zhang Zhen-Hao, Hu Zhao, Yao Yan
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Geriatr Cardiol. 2023 Feb 28;20(2):121-129. doi: 10.26599/1671-5411.2023.02.003.
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, < 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, = 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.
肾去神经支配术（RDN）是一种基于导管介入的、用于治疗顽固性高血压患者的有前景的治疗方法。然而，其在单纯收缩期高血压（ISH）患者中的疗效仍存在争议。本荟萃分析的目的是确定与收缩期/舒张期联合高血压（CH）患者相比，RDN对ISH患者的降压效果。
检索PubMed、Embase、Cochrane和ClinicalTrials.gov，查找纳入RDN的前瞻性临床研究。感兴趣的结局是24小时动态收缩压（SBP）相对于基线的变化。我们使用固定效应模型计算加权平均差（WMD）及95%置信区间（CI）。
纳入六项试验，共1405名参与者，其中包括597名ISH患者和808名CH患者。平均随访时间为五个月。CH患者24小时动态SBP的降低幅度显著大于ISH患者（WMD = 3.89，95% CI：2.32 - 5.45，P < 0.0001）。与ISH患者相比，RDN在CH患者的诊室SBP降低方面也表现出更大幅度（WMD = 10.24，95% CI：4.24 - 15.74，P = 0.0003）。并且该效应与年龄、随访时间和消融装置无关。
与ISH患者相比，RDN在CH患者中能提供更好的血压控制，CH患者可能是最适合接受RDN治疗的人群。
