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比较肾动脉去神经支配术治疗难治性高血压的疗效：一项系统评价和网状Meta分析

Comparing the Efficacy of Renal Artery Denervation in Uncontrolled Hypertension: A Systematic Review and Network Meta-Analysis.

作者信息

Abouelmagd Alaa Abdrabou, Hassanein Maged Elsayed, Shehata Rana Ibrahim Abdalla, Kaoud Omar A, Hamouda Heba, Abbas Omar F, Gaballah Mohab

机构信息

Medicine, South Valley University, Qena, EGY.

Cardiology, Medical Research Group of Egypt, Negida Academy, Arlington, USA.

出版信息

Cureus. 2024 Oct 4;16(10):e70805. doi: 10.7759/cureus.70805. eCollection 2024 Oct.

DOI:10.7759/cureus.70805
PMID:39493034
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11531912/
Abstract

The study aims to compare the outcomes of different renal denervation (RDN) procedures in the treatment of uncontrolled hypertension. We searched Scopus, PubMed, Web of Science, and Cochrane for RCTs evaluating different procedures of RDN for hypertension. The outcomes of this study were systolic blood pressure (SBP) daytime, diastolic blood pressure (DBP) daytime, SBP nighttime, DBP nighttime, SBP 24-hour, DBP 24-hour, SBP home, DBP home, SBP office, and DBP office. We did a frequentist network meta-analysis of 38 published RCTs evaluating the efficacy of different renal artery denervation procedures for uncontrolled hypertension compared to sham procedures or standardized stepped-care antihypertensive treatment (SSAHT). Radiofrequency (RF) alone showed a statistically significant reduction in DBP (24 hours), DBP (daytime), and DBP (nighttime): standardized mean difference (SMD): -2.01 (95% CI: (-3.34; -0.68)), SMD: -4.36 (95% CI: (-8.28; -0.44)), and SMD: -3.50 (95% CI: (-6.23; -0.76)), respectively, and showed a statistically significant reduction in SBP (24 hours), SBP (daytime), and SBP (nighttime): SMD: -3.93 (95% CI: (-6.01; -1.84)), SMD: -5.88 (95% CI: (-9.91; -1.85)), and SMD: -5.79 (95% CI: (-10.0; -1.58)), respectively. RF added to SSAHT has statistical significance in the reduction of DBP (nighttime), SBP (daytime), SBP (home), and SBP (nighttime) with a SMD of -7.63 (95% CI: (-14.21; -1.06)), SMD of -10.56 (95% CI: (-21.03; -0.08)), SMD of -23.20 (95% CI: (-36.72; -9.26)), and SMD of -14.03 (95% CI: (-25.43; -2.63)), respectively. We found that renal denervation, especially by RF, when added to SSAHT may be a promising therapeutic option for patients with treatment-resistant hypertension, particularly in cases where medication alone fails to achieve adequate blood pressure control.

摘要

本研究旨在比较不同肾去神经支配（RDN）手术治疗难治性高血压的效果。我们在Scopus、PubMed、Web of Science和Cochrane数据库中检索了评估不同RDN手术治疗高血压的随机对照试验（RCT）。本研究的结局指标为日间收缩压（SBP）、日间舒张压（DBP）、夜间SBP、夜间DBP、24小时SBP、24小时DBP、家庭SBP、家庭DBP、诊室SBP和诊室DBP。我们对38项已发表的RCT进行了频率学派网状Meta分析，评估了不同肾动脉去神经支配手术与假手术或标准化阶梯式降压治疗（SSAHT）相比治疗难治性高血压的疗效。单纯射频消融（RF）在降低DBP（24小时）、DBP（日间）和DBP（夜间）方面具有统计学意义：标准化均数差（SMD）分别为-2.01（95%CI：（-3.34；-0.68））、-4.36（95%CI：（-8.28；-0.44））和-3.50（95%CI：（-6.23；-0.76）），在降低SBP（24小时）、SBP（日间）和SBP（夜间）方面也具有统计学意义：SMD分别为-3.93（95%CI：（-6.01；-1.84））、-5.88（95%CI：（-9.91；-1.85））和-5.79（95%CI：（-10.0；-1.58））。RF联合SSAHT在降低夜间DBP、日间SBP、家庭SBP和夜间SBP方面具有统计学意义，SMD分别为-7.63（95%CI：（-14.21；-1.06））、-10.56（95%CI：（-21.03；-0.08））、-23.20（95%CI：（-36.72；-9.26））和-14.03（95%CI：（-25.43；-2.63））。我们发现，肾去神经支配，尤其是RF联合SSAHT，对于难治性高血压患者可能是一种有前景的治疗选择，特别是在单纯药物治疗无法实现充分血压控制的情况下。

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JAMA. 2023 Feb 28;329(8):651-661. doi: 10.1001/jama.2023.0713.
2
Effects of Renal Denervation vs Sham in Resistant Hypertension After Medication Escalation: Prespecified Analysis at 6 Months of the RADIANCE-HTN TRIO Randomized Clinical Trial.药物升级后抵抗性高血压行肾去神经术与假手术对照的效果：RADIANCE-HTN TRIO 随机临床试验 6 个月时的预设分析。
JAMA Cardiol. 2022 Dec 1;7(12):1244-1252. doi: 10.1001/jamacardio.2022.3904.
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Long-term reduction in morning and nighttime blood pressure after renal denervation: 36-month results from SPYRAL HTN-ON MED trial.
肾动脉去神经术治疗后晨晚间血压的长期降低：SPYRAL HTN-ON MED 试验 36 个月结果。
Hypertens Res. 2023 Jan;46(1):280-288. doi: 10.1038/s41440-022-01042-8. Epub 2022 Oct 15.
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Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial.在使用抗高血压药物的情况下肾动脉去神经术的长期疗效和安全性（SPYRAL HTN-ON MED）：一项随机、假手术对照试验。
Lancet. 2022 Apr 9;399(10333):1401-1410. doi: 10.1016/S0140-6736(22)00455-X. Epub 2022 Apr 4.
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