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

Abstract

Aims Radiofrequency (RF) renal denervation (RDN) safely lowers office and 24-h blood pressure (BP). This meta-analysis examined the long-term durability of RF RDN based on randomized trials and observational studies. Methods and results 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-h BP change from baseline as well as changes in anti-hypertensive drugs. A random effects meta-analysis was conducted over 3 years, or the last reported follow-up beyond 3 years. A total of 2212 patients identified among 18 reports were evaluated for BP. The mean duration of follow-up was 4.4 years (range 3–9.4). The long-term reduction in office systolic BP from baseline in 15 reports (n = 2040) was −23.0 mmHg (95% confidence interval: −26.8 to −19.1, P < 0.05) for the random effects model and −20.5 (−21.6 to −19.4) for the fixed effect model. Twenty-four-hour ambulatory systolic BP was available in 11 reports (n = 1018) 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-h 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 anti-hypertensive drugs and eGFR also decreased. Heart rate remained unchanged through the final follow-up in both models. Safety events were rare, with a mean rate of renal artery complications of 0.14% (0.08–0.20%). Conclusion 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 anti-hypertensive medication. Lay summary This meta-analysis of 18 studies and over 2000 patients demonstrated sustained and significant office and ambulatory blood pressure (BP) reductions following radiofrequency renal denervation for uncontrolled hypertension through at least 3 years without an increase in anti-hypertensive medication. Office systolic BP decreased by −23.0 mmHg (95% confidence interval: −26.8 to −19.1, P < 0.05). •Twenty-four-hour ambulatory systolic BP decreased by −13.6 mmHg (−16.5 to −10.8, P < 0.05).