Mahfoud Felix, Kandzari David E, Schlaich Markus P, Schmieder Roland E, Lauder Lucas, Ruilope Luis, Narkiewicz Krzysztof, Williams Bryan, Hettrick Douglas A, Lung Te-Hsin, Ribichini Flavio, Weil Joachim, Sharif Faisal, Mancia Giuseppe, Böhm Michael
Department of Cardiology, University Heart Center, University Hospital Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University Heart Center, University Hospital Basel, Switzerland.
Piedmont Heart Institute, Atlanta, GA.
Eur J Prev Cardiol. 2025 Jul 15. doi: 10.1093/eurjpc/zwaf368.
Radiofrequency renal denervation (RF RDN) safely lowers office and 24-hour blood pressure (BP). This meta-analysis examined the long-term durability of RF RDN based on randomized trials and observational studies.
Patients with uncontrolled hypertension undergoing RF RDN using the Symplicity Flex™ or Spyral™ device and a minimum follow-up of 3 years were included. Key outcomes included office and 24-hour BP change from baseline as well as changes in antihypertensive drugs. A random effects meta-analysis was conducted through 3 years, or the last reported follow-up beyond 3 years.
A total of 2,212 patients identified among 18 reports were evaluated for BP. Mean duration of follow-up was 4.4 years (range 3 to 9.4). The long-term reduction in office systolic BP (OSBP) from baseline in 15 reports (N= 2,040) was -23.0 mmHg (95%CI: -26.8 to -19.1, p<0.05) for the random effects model and -. 24-hour ambulatory systolic BP was available in 11 reports (n=1,018) and decreased significantly by -13.6 mmHg (-16.5 to -10.8, p<0.05). Fixed effect model results were similar. Diastolic office and 24-hr BP paralleled these findings in both models. Nighttime systolic BP also decreased significantly by -14.2 mmHg (-27.6 to -0.8, p<0.05). The number of prescribed antihypertensive drugs and eGFR also decreased. Heart rate remained unchanged through final follow-up in both models. Safety events were rare, with a mean rate of renal artery complication of 0.14% (0.08% to 0.20%).
This meta-analysis comprising 18 studies demonstrated sustained and significant office and ambulatory BP reductions following Symplicity RDN through at least 3 years without an increase in antihypertensive medication.
射频肾去神经术（RF RDN）可安全降低诊室血压和24小时血压（BP）。本荟萃分析基于随机试验和观察性研究，探讨了RF RDN的长期疗效持久性。
纳入使用Symplicity Flex™或Spyral™设备进行RF RDN且未控制高血压的患者，且至少随访3年。主要结局包括诊室血压和24小时血压相对于基线的变化以及降压药物的变化。通过3年或最后报告的超过3年的随访进行随机效应荟萃分析。
在18份报告中确定的2212例患者接受了血压评估。平均随访时间为4.4年（范围3至9.4年）。15份报告（N = 2040）中，随机效应模型显示，相对于基线，诊室收缩压（OSBP）的长期降低为-23.0 mmHg（95%CI：-26.8至-19.1，p<0.05），固定效应模型结果相似。11份报告（n = 1018）中有24小时动态收缩压数据，其显著降低了-13.6 mmHg（-16.5至-10.8，p<0.05）。诊室舒张压和24小时舒张压在两种模型中与这些结果相似。夜间收缩压也显著降低了-14.2 mmHg（-27.6至-0.8，p<0.05）。处方降压药物数量和估算肾小球滤过率（eGFR）也有所下降。两种模型在最终随访时心率均保持不变。安全事件罕见，肾动脉并发症的平均发生率为0.14%（0.08%至0.20%）。
这项包含18项研究的荟萃分析表明，Symplicity RDN术后至少3年，诊室血压和动态血压持续且显著降低，同时降压药物未增加。
