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Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials

Comparative efficacy and safety of renal denervation (RDN) interventions for uncontrolled (UH) and resistant hypertension (RH) is unknown. We assessed the comparative efficacy and safety of existing RDN interventions for UH and RH. Six search engines were searched up to 1 May 2020. Primary outcomes...

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Autores principales: Silverwatch, Jonathan, Marti, Kristen E., Phan, Mi T., Amin, Hinali, Roman, Yuani M., Pasupuleti, Vinay, Banach, Maciej, Barboza, Joshuan J., Hernandez, Adrian V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919811/
https://www.ncbi.nlm.nih.gov/pubmed/33669195
http://dx.doi.org/10.3390/jcm10040782
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author Silverwatch, Jonathan
Marti, Kristen E.
Phan, Mi T.
Amin, Hinali
Roman, Yuani M.
Pasupuleti, Vinay
Banach, Maciej
Barboza, Joshuan J.
Hernandez, Adrian V.
author_facet Silverwatch, Jonathan
Marti, Kristen E.
Phan, Mi T.
Amin, Hinali
Roman, Yuani M.
Pasupuleti, Vinay
Banach, Maciej
Barboza, Joshuan J.
Hernandez, Adrian V.
author_sort Silverwatch, Jonathan
collection PubMed
description Comparative efficacy and safety of renal denervation (RDN) interventions for uncontrolled (UH) and resistant hypertension (RH) is unknown. We assessed the comparative efficacy and safety of existing RDN interventions for UH and RH. Six search engines were searched up to 1 May 2020. Primary outcomes were mean 24-h ambulatory and office systolic blood pressure (SBP). Secondary outcomes were mean 24-h ambulatory and office diastolic blood pressure (DBP), clinical outcomes, and serious adverse events. Frequentist random-effects network meta-analyses were used to evaluate effects of RDN interventions. Twenty randomized controlled trials (RCTs) (n = 2152) were included, 15 in RH (n = 1544) and five in UH (n = 608). Intervention arms included radiofrequency (RF) in main renal artery (MRA) (n = 10), RF in MRA and branches (n = 4), RF in MRA+ antihypertensive therapy (AHT) (n = 5), ultrasound (US) in MRA (n = 3), sham (n = 8), and AHT (n = 9). RF in MRA and branches ranked as the best treatment to reduce 24-h ambulatory, daytime, and nighttime SBP and DBP versus other interventions (p-scores: 0.83 to 0.97); significant blood pressure effects were found versus sham or AHT. RF in MRA+AHT was the best treatment to reduce office SBP and DBP (p-scores: 0.84 and 0.90, respectively). RF in MRA and branches was the most efficacious versus other interventions to reduce 24-h ambulatory SBP and DBP in UH or RH.
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spelling pubmed-79198112021-03-02 Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials Silverwatch, Jonathan Marti, Kristen E. Phan, Mi T. Amin, Hinali Roman, Yuani M. Pasupuleti, Vinay Banach, Maciej Barboza, Joshuan J. Hernandez, Adrian V. J Clin Med Review Comparative efficacy and safety of renal denervation (RDN) interventions for uncontrolled (UH) and resistant hypertension (RH) is unknown. We assessed the comparative efficacy and safety of existing RDN interventions for UH and RH. Six search engines were searched up to 1 May 2020. Primary outcomes were mean 24-h ambulatory and office systolic blood pressure (SBP). Secondary outcomes were mean 24-h ambulatory and office diastolic blood pressure (DBP), clinical outcomes, and serious adverse events. Frequentist random-effects network meta-analyses were used to evaluate effects of RDN interventions. Twenty randomized controlled trials (RCTs) (n = 2152) were included, 15 in RH (n = 1544) and five in UH (n = 608). Intervention arms included radiofrequency (RF) in main renal artery (MRA) (n = 10), RF in MRA and branches (n = 4), RF in MRA+ antihypertensive therapy (AHT) (n = 5), ultrasound (US) in MRA (n = 3), sham (n = 8), and AHT (n = 9). RF in MRA and branches ranked as the best treatment to reduce 24-h ambulatory, daytime, and nighttime SBP and DBP versus other interventions (p-scores: 0.83 to 0.97); significant blood pressure effects were found versus sham or AHT. RF in MRA+AHT was the best treatment to reduce office SBP and DBP (p-scores: 0.84 and 0.90, respectively). RF in MRA and branches was the most efficacious versus other interventions to reduce 24-h ambulatory SBP and DBP in UH or RH. MDPI 2021-02-16 /pmc/articles/PMC7919811/ /pubmed/33669195 http://dx.doi.org/10.3390/jcm10040782 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Silverwatch, Jonathan
Marti, Kristen E.
Phan, Mi T.
Amin, Hinali
Roman, Yuani M.
Pasupuleti, Vinay
Banach, Maciej
Barboza, Joshuan J.
Hernandez, Adrian V.
Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials
title Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials
title_full Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials
title_fullStr Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials
title_full_unstemmed Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials
title_short Renal Denervation for Uncontrolled and Resistant Hypertension: Systematic Review and Network Meta-Analysis of Randomized Trials
title_sort renal denervation for uncontrolled and resistant hypertension: systematic review and network meta-analysis of randomized trials
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919811/
https://www.ncbi.nlm.nih.gov/pubmed/33669195
http://dx.doi.org/10.3390/jcm10040782
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