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

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

Alaa Abdrabou Abouelmagd  1   2 , Maged Elsayed Hassanein  3 , Rana Ibrahim Abdalla Shehata  4 , Omar A Kaoud  5 , Heba Hamouda  6 , Omar F Abbas  7 , Mohab Gaballah  8
Affiliations
Review

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

Alaa Abdrabou Abouelmagd et al. Cureus. .

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.

Keywords: hypertension; network meta-analysis; radiofrequency; renal artery; renal denervation.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta‐analyses
Figure 2
Figure 2. (a) Network geometry of DBP (24 hours). (b) Forest plot of change of DBP (24 hours) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in DBP (24 hours)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; DBP: diastolic blood pressure; SMD: standardized mean difference
Figure 3
Figure 3. (a) Network geometry of DBP (daytime). (b) Forest plot of change of DBP (daytime) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in DBP (daytime)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; DBP: diastolic blood pressure; SMD: standardized mean difference
Figure 4
Figure 4. (a) Network geometry of DBP (home). (b) Forest plot of change of DBP (home) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in DBP (home)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; DBP: diastolic blood pressure; SMD: standardized mean difference
Figure 5
Figure 5. (a) Network geometry of DBP (nighttime). (b) Forest plot of change of DBP (nighttime) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in DBP (nighttime)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; DBP: diastolic blood pressure; SMD: standardized mean difference
Figure 6
Figure 6. (a) Network geometry of DBP (office). (b) Forest plot of change of DBP (office) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in DBP (office)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; DBP: diastolic blood pressure; SMD: standardized mean difference
Figure 7
Figure 7. (a) Network geometry of SBP (24 hours). (b) Forest plot of change of SBP (24 hours) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in SBP (24 hours)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; SBP: systolic blood pressure; SMD: standardized mean difference
Figure 8
Figure 8. (a) Network geometry of SBP (daytime). (b) Forest plot of change of SBP (daytime) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in SBP (daytime)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; SBP: systolic blood pressure; SMD: standardized mean difference
Figure 9
Figure 9. (a) Network geometry of SBP (home). (b) Forest plot of change of SBP (home) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in SBP (home)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; SBP: systolic blood pressure; SMD: standardized mean difference
Figure 10
Figure 10. (a) Network geometry of SBP (nighttime). (b) Forest plot of change of SBP (nighttime) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in SBP (nighttime)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; SBP: systolic blood pressure; SMD: standardized mean difference
Figure 11
Figure 11. (a) Network geometry of SBP (office). (b) Forest plot of change of SBP (office) by different renal denervation interventions. (c) Direct versus indirect evidence of the change in SBP (office)
SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency; SBP: systolic blood pressure; SMD: standardized mean difference
Figure 12
Figure 12. ROB graph
Reference: [17,18,20-25,29-58] ROB: risk of bias
Figure 13
Figure 13. ROB summary
ROB: risk of bias
Figure 14
Figure 14. Funnel plot publication bias of DBP 24 hours
DBP: diastolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 15
Figure 15. Funnel plot publication bias of DBP daytime
DBP: diastolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 16
Figure 16. Funnel plot publication bias of DBP home
DBP: diastolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 17
Figure 17. Funnel plot publication bias of DBP nighttime
DBP: diastolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 18
Figure 18. Funnel plot publication bias of DBP office
DBP: diastolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 19
Figure 19. Funnel plot publication bias of SBP 24 hours
SBP: systolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 20
Figure 20. Funnel plot publication bias of SBP daytime
SBP: systolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 21
Figure 21. Funnel plot publication bias of SBP home
SBP: systolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 22
Figure 22. Funnel plot publication bias of SBP nighttime
SBP: systolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
Figure 23
Figure 23. Funnel plot publication bias of SBP office
SBP: systolic blood pressure; SSAHT: standardized stepped-care antihypertensive treatment; RF: radiofrequency
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