Long-term outcomes following radiofrequency renal denervation: meta-analysis of 18 reports

Abstract

Aims: 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.

Methods: 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.

Results: 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%).

Conclusions: 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.