Safety and Blood Pressure Outcomes of Renal Denervation for Resistant Hypertension: Meta-Analysis of Randomized Trials

Author(s): Arhum Mahmood, Mohamed Aboelmaaty, Ghazala S. Virk, Sumaiya Khan, Abdul Hanan, Zain Bin Saeed, Sara Zubair Ahmed, Muhammad Ahmer Sohaib, Ahmad Sheraz Iqbal, Binish Essani, Marium Abid, Muhammad Sohail S. Mirza

Background: Catheter-based renal denervation (RDN) is a potential nonpharmacological treatment for resistant hypertension, though its efficacy and safety require further validation. This meta-analysis compared RDN to sham procedures on blood pressure (BP) outcomes and safety.

Methods: We pooled data from 6 randomized controlled trials (999 patients) using random-effects models. Primary outcomes were changes in 24-hour ambulatory systolic/diastolic BP (SBP/DBP) and office SBP. Safety assessed adverse events and renal function. Heterogeneity was evaluated via I².

Results: RDN significantly reduced 24-hour ambulatory DBP (SMD: -0.23; 95% CI: -0.47, -0.00; p=0.05) and office SBP (SMD: -0.29; 95% CI: -0.50, -0.08; p=0.007) versus sham. The reduction in 24-hour ambulatory SBP was not significant (SMD: -0.21; 95% CI: -0.47, 0.05; p=0.11). Adverse event rates and renal function changes were similar between groups (p=0.86). Analyses showed moderate-to-high heterogeneity (I²=62%-69%).

Conclusions: RDN effectively lowers ambulatory DBP and office SBP with a favorable safety profile. Its effect on ambulatory SBP remains uncertain. While a promising option for resistant hypertension, standardized protocols and long-term data are needed to confirm efficacy and durability.