OBJECTIVES: Hypertension remains a significant clinical and public health challenge as a leading cause of morbidity and mortality worldwide. Renal denervation (RDN) is a procedure that aims to treat uncontrolled hypertension, including resistant hypertension. The objective of this systematic review (SR) and meta-analyses (MA) was to assess the efficacy of RDN compared with no RDN or sham control in patients with uncontrolled hypertension.

METHODS: A SR, adhering to Cochrane and PRISMA guidance, was undertaken to identify randomised controlled trials (RCTs) of ultrasound or radiofrequency, catheter-based RDN. Eligible RCTs included adult patients with uncontrolled hypertension (office blood pressure ≥140/90mmHg, with/without any previous baseline antihypertensive medication). Key outcomes included office and 24-hour ambulatory blood pressure change from baseline. A feasibility assessment was conducted to assess the suitability of included trials for MA. Random effects (RE) MAs were conducted at the primary endpoint and last reported follow-up. The robustness of these results was assessed in a series of sensitivity and subgroup analyses.

RESULTS: Searches conducted between November 2022 and May 2023 identified 6,298 records. Following screening, 25 RCTs were included. Four trials classified as “off-med” (trials in patients not receiving antihypertensive medication) and 12 trials as “on-med” (patients receiving the same regimen of antihypertensive medication) were suitable for MA. A RE MA for office systolic blood pressure (SBP) estimated a mean difference of -8.5 (95% CI: -13.4 to -3.5) at the primary endpoint and -7.2 (95% CI: -12.5 to -2.0) at last follow-up between RDN and the control group. For 24-hour ambulatory SBP, the mean difference was -3.7 (95% CI: -5.3 to -2.0) and -3.3 (95% CI: -5.0 to -1.6) at the primary endpoint and last follow-up respectively.

CONCLUSIONS: There is robust evidence to suggest that RDN is effective in achieving clinically meaningful blood pressure reductions compared to no RDN or sham among patients with uncontrolled hypertension.