Renal denervation for treatment of resistant hypertension

Mitchell MD, Grady MS, Mull NK
Record ID 32018012103
Authors' results and conclusions: Summary of results We found three health technology assessment reports on this technology published from 2019 to the present, plus a Cochrane review. Our summary is based on the evidence tables and findings of those reports. Cochrane’s meta-analysis of clinical trial results showed that renal denervation reduced systolic and diastolic blood pressure by 4-6 mmHg, with considerable uncertainty in the magnitude of the effect. The finding was statistically significant for blood pressure measured in the office, but did not reach statistical significance for 24-hour measurement. Cochrane reviewers appraised the evidence to be moderate in strength. Reviewers from HTA Wales also meta-analyzed results: their conclusions emphasized lack of statistical significance in the effect of renal denervation on systolic or diastolic blood pressure. Clinical outcomes including hospitalization, myocardial infarction, stroke, and death were reported in many of the clinical trials but follow-up was short and effects were small and not statistically significant. The evidence grade for these outcomes is low due to the high imprecision of these results. Longer-term studies are in progress. Meta-analyses found little or no effect of these treatments on renal function as measured by eGFR or creatinine clearance. The evidence grade for these outcomes is low because of imprecision and inconsistency. NICE concluded that there was a low incidence of complications from the procedure but long-term safety data are lacking. There was not enough evidence to allow for any conclusions about the comparative safety of RF and ultrasound renal denervation or for conclusions about whether procedure safety and effectiveness was affected by the scope of ablation (in the renal artery alone or the renal artery plus branches). The bulk of the evidence was from trials of RF procedures. Subgrouping in the meta-analyses did not find significant differences in results between RF and ultrasound procedures, but the certainty in the meta-analytic findings for ultrasound is low, so additional evidence may discern a difference in effectiveness between the two technologies. One trial found ultrasound procedures to have a larger effect on systolic blood pressure than RF procedures. None of the HTA reports came to any conclusions about the comparative safety and effectiveness of the two types of devices.
Authors' methods: About Rapid Product Summaries A CEP Rapid Product Summary is a limited search for existing health technology assessment reports and other key secondary sources relating to a specific device, drug, diagnostic test, or procedure. It does not include a search for or review of primary evidence. Searches are not comprehensive, and the results must not be taken as definitive. Additional studies may exist, including studies whose findings may differ from those cited in this report or identify significant limitations in their clinical applicability. While the organizations included in the search are reliable sources of health technology assessment information, CEP cannot guarantee the accuracy and completeness of cited reports.
Project Status: Completed
Year Published: 2024
Requestor: supply chain purchasing
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Denervation
  • Hypertension
  • Radiofrequency Ablation
  • Renal Artery
  • Antihypertensive Agents
  • Sympathectomy
  • Blood Pressure
  • Catheter Ablation
  • ultrasound
  • radiofrequency
  • HTN
  • ablation
  • catheter
Organisation Name: Penn Medicine Center for Evidence-based Practice
Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104
Contact Name: Nikhil Mull
Contact Email:
Copyright: <p>Center for Evidence-based Practice (CEP)</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.