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Effect of renal sympathetic denervation on short-term blood pressure variability in resistant hypertension: a meta-analysis

Vogiatzakis, Nikosa; Tsioufis, Costasa; Georgiopoulos, Georgiosa; Thomopoulos, Costasa; Dimitriadis, Kyriakosa; Kasiakogias, Alexandrosa; Konstantinidis, Dimitriosa; Kalos, Thodorisa; Mahfoud, Felixb; Doumas, Michaelc; Papademetriou, Vasiliosd; Tousoulis, Dimitriosa

doi: 10.1097/HJH.0000000000001391

Background/objectives: Short-term blood pressure variability (BPV) is affected by multiple factors including the sympathetic nervous system drive. Regarding the latter, the novel interventional technology of renal denervation (RDN), by modulating the sympathetic system activation, could have a beneficial impact on BPV. The aim of the current study is to review and meta-analyze the available evidence on the effect of RDN on short-term BPV.

Methods: We searched Medline/PubMed database until October 2016 for studies with eligible content. We performed random-effect meta-analyses for 12 outcomes of interest: the standard deviation (SD) of SBP (24 h, daytime and night-time) and DBP (24 h, daytime and night-time), the weighted SD of SBP and DBP across 24 h, the coefficient of variation of SBP and DBP across 24 h and the average real variability of SBP and DBP across 24 h.

Results: RDN reduced the SD of SBP across 24 h [mean change: −1.212 (95% confidence intervals (CIs): −2.354/−0.071), P = 0.037] and decreased the SD of systolic daytime BP [mean difference: −1.617 (95% CIs: −3.21/−0.026), P = 0.046] and diastolic daytime BP (marginally) [mean difference: −2.605 (95% CIs: −5.21/−0.003), P = 0.05]. The effect of RDN in reducing SD of SBP across 24 h or DBP across daytime was not influenced by absolute or relative reduction in SBP and DBP indices. (P > 0.1 for all).

Conclusion: Catheter-based RDN in resistant hypertensive patients can favorably affect short-term BPV, independent of the level of BP reduction. Further investigation of the effect of RDN on BPV is needed with large randomized trials.

aFirst Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece

bDepartment of Internal Medicine, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Saarland, Germany

cSecond Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece

dVeteran Affairs Medical Center and Georgetown University, Washington, District of Columbia, USA

Correspondence to Costas Tsioufis, MD, First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 114 Vas. Sofias Ave, 11527 Athens, Greece. Tel: +30 2132089522; fax: +30 2132089522; e-mail:

Abbreviations: ARV, average real variability; BP, blood pressure; BPV, blood pressure variability; CV, coefficient of variation; ISH, isolated systolic hypertension; RDN, renal denervation

Received 11 January, 2017

Revised 13 March, 2017

Accepted 27 March, 2017

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