Efficacy and Safety of Radiofrequency-Based Renal Denervation on Resistant Hypertensive Patients: A Systematic Review and Meta-analysis.

Introduction: New therapies for resistant hypertension (RH), including renal denervation (RDN), have been studied. Aim: Access the safety and effectiveness of radiofrequency-based RDN vs pharmacological treatment for RH. Methods: A thorough literature search was conducted across PubMed, EMBASE, and the Cochrane databases, focusing on studies that compared the effects of radiofrequency-based RDN versus pharmacological treatment for RH. Treatment effects for binary and continuous endpoints were pooled and used, respectively, odds-ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) to analyze continuous outcomes. Results: In the 10 included studies, involving 1.182 patients, 682 received radiofrequency-based RDN. The follow-up period ranged from 6 to 84 months. Analysis revealed that the RDN group had a significant reduction in office systolic blood pressure (BP) (MD − 9.5 mmHg; 95% CI − 16.81 to − 2.29; P = 0.01), office diastolic BP (MD − 5.1 mmHg; 95% CI − 8.42 to − 2.80; P < 0.001), 24 h systolic BP (MD − 4.8 mmHg; 95% CI − 7.26 to − 2.42; P < 0.001). For 24 h diastolic BP RDN did not have a significant reduction (MD − 2.3 mmHg; 95% CI − 4.19 to − 0.52; P = 0.012). The heterogeneity between the studies was high, visible in the funnel and Baujat plots. The OR was non-significant for non-serious adverse events, but also clinically significant for hypertensive crises and strokes for the RDN group. Conclusions: While the pharmacological regimen of 3 or more anti-hypertensive, including a diuretic, still be the first-line option for RH treatment, our results support that radiofrequency-based RDN is superior in reducing global BP and is safe. [ABSTRACT FROM AUTHOR]