Singh Sahib, Rout Amit, Garg Aakash
Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Division of Cardiology, University of Louisville, Louisville, Kentucky, USA.
Catheter Cardiovasc Interv. 2023 Oct;102(4):663-671. doi: 10.1002/ccd.30796. Epub 2023 Aug 6.
Radiofrequency or ultrasound renal denervation (RDN) has shown conflicting results when used as an adjunctive option for hypertension management in randomized controlled trials (RCTs).
We searched Pubmed, MEDLINE, and other online databases for RCTs comparing RDN versus sham-control procedures in patients with uncontrolled or resistant hypertension. The endpoints of interest were 24-h ambulatory (AMB) blood pressure (BP), daytime AMB BP, and office BP. We performed a random-effects meta-analysis using the inverse variance method to estimate mean difference (MD) with a 95% confidence interval (CI).
Nine studies with 1643 patients were included in the final analysis. The mean follow-up was 5 months. As compared with the sham-controlled group, RDN was associated with a significant decrease in 24-h AMB BP (systolic [MD -4.20; 95% CI -5.36 to -3.03; p < 0.00001], diastolic [-2.38; -3.42 to -1.35]), and daytime AMB BP (systolic: -5.11; -6.75 to -3.47, diastolic: -2.88; -3.91 to -1.85). Similarly, office BP was reduced with RDN (systolic: -5.46; -7.12 to -3.81; diastolic: -3.17; -4.23 to -2.12) when compared with placebo.
Our meta-analysis shows that RDN is associated with a significant reduction in the 24-h AMB BP, daytime AMB BP, and office BP.
在随机对照试验（RCT）中，将射频或超声肾去神经支配术（RDN）用作高血压管理的辅助方法时，结果存在矛盾。
我们在PubMed、MEDLINE和其他在线数据库中搜索了比较RDN与假对照程序治疗未控制或顽固性高血压患者的RCT。感兴趣的终点是24小时动态（AMB）血压（BP）、日间AMB血压和诊室血压。我们采用逆方差法进行随机效应荟萃分析，以估计平均差（MD）及其95%置信区间（CI）。
最终分析纳入了9项研究中的1643例患者。平均随访时间为5个月。与假对照组相比，RDN与24小时AMB血压显著降低相关（收缩压[MD -4.20；95%CI -5.36至-3.03；p < 0.00001]，舒张压[-2.38；-3.42至-1.35]），以及日间AMB血压（收缩压：-5.11；-6.75至-3.47，舒张压：-2.88；-3.91至-1.85）。同样，与安慰剂相比，RDN可降低诊室血压（收缩压：-5.46；-7.12至-3.81；舒张压：-3.17；-4.23至-2.12）。
我们的荟萃分析表明，RDN与24小时AMB血压、日间AMB血压和诊室血压的显著降低相关。
