Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis
Background: Catheter-based renal denervation (RDN) is a novel treatment for resistant hypertension (RH). A recent meta-analysis reported that RDN did not significantly reduce blood pressure (BP) based on the pooled effects with mild to severe heterogeneity. The aim of the present study was to identi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2017-01-01
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| Series: | Chinese Medical Journal |
| Subjects: | |
| Online Access: | http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=13;spage=1586;epage=1594;aulast=Chen |
| _version_ | 1818038041460080640 |
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| author | Xiao-Han Chen Sehee Kim Xiao-Xi Zeng Zhi-Bing Chen Tian-Lei Cui Zhang-Xue Hu Yi Li Ping Fu |
| author_facet | Xiao-Han Chen Sehee Kim Xiao-Xi Zeng Zhi-Bing Chen Tian-Lei Cui Zhang-Xue Hu Yi Li Ping Fu |
| author_sort | Xiao-Han Chen |
| collection | DOAJ |
| description | Background: Catheter-based renal denervation (RDN) is a novel treatment for resistant hypertension (RH). A recent meta-analysis reported that RDN did not significantly reduce blood pressure (BP) based on the pooled effects with mild to severe heterogeneity. The aim of the present study was to identify and reduce clinical sources of heterogeneity and reassess the safety and efficacy of RDN within the identified homogeneous subpopulations.
Methods: This was a meta-analysis of 9 randomized clinical trials (RCTs) among patients with RH up to June 2016. Sensitivity analyses and subgroup analyses were extensively conducted by baseline systolic blood pressure (SBP) level, antihypertensive medication change rates, and coronary heart disease (CHD).
Results: In all patients with RH, no statistical differences were found in mortality, severe cardiovascular events rate, and changes in 24-h SBP and office SBP at 6 and 12 months. However, subgroup analyses showed significant differences between the RDN and control groups. In the subpopulations with baseline 24-h SBP ≥155 mmHg (1 mmHg = 0.133 kPa) and the infrequently changed medication, the use of RDN resulted in a significant reduction in 24-h SBP level at 6 months (P = 0.100 and P= 0.009, respectively). Subgrouping RCTs with a higher prevalent CHD in control showed that the control treatment was significantly better than RDN in office SBP reduction at 6 months (P < 0.001).
Conclusions: In all patients with RH, the catheter-based RDN is not more effective in lowering ambulatory or office BP than an optimized antihypertensive drug treatment at 6 and 12 months. However, among RH patients with higher baseline SBP, RDN might be more effective in reducing SBP. |
| first_indexed | 2024-12-10T07:36:26Z |
| format | Article |
| id | doaj.art-8d45bdc534b642659730b3b809181217 |
| institution | Directory Open Access Journal |
| issn | 0366-6999 |
| language | English |
| last_indexed | 2024-12-10T07:36:26Z |
| publishDate | 2017-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Chinese Medical Journal |
| spelling | doaj.art-8d45bdc534b642659730b3b8091812172022-12-22T01:57:25ZengWolters KluwerChinese Medical Journal0366-69992017-01-01130131586159410.4103/0366-6999.208238Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysisXiao-Han ChenSehee KimXiao-Xi ZengZhi-Bing ChenTian-Lei CuiZhang-Xue HuYi LiPing FuBackground: Catheter-based renal denervation (RDN) is a novel treatment for resistant hypertension (RH). A recent meta-analysis reported that RDN did not significantly reduce blood pressure (BP) based on the pooled effects with mild to severe heterogeneity. The aim of the present study was to identify and reduce clinical sources of heterogeneity and reassess the safety and efficacy of RDN within the identified homogeneous subpopulations. Methods: This was a meta-analysis of 9 randomized clinical trials (RCTs) among patients with RH up to June 2016. Sensitivity analyses and subgroup analyses were extensively conducted by baseline systolic blood pressure (SBP) level, antihypertensive medication change rates, and coronary heart disease (CHD). Results: In all patients with RH, no statistical differences were found in mortality, severe cardiovascular events rate, and changes in 24-h SBP and office SBP at 6 and 12 months. However, subgroup analyses showed significant differences between the RDN and control groups. In the subpopulations with baseline 24-h SBP ≥155 mmHg (1 mmHg = 0.133 kPa) and the infrequently changed medication, the use of RDN resulted in a significant reduction in 24-h SBP level at 6 months (P = 0.100 and P= 0.009, respectively). Subgrouping RCTs with a higher prevalent CHD in control showed that the control treatment was significantly better than RDN in office SBP reduction at 6 months (P < 0.001). Conclusions: In all patients with RH, the catheter-based RDN is not more effective in lowering ambulatory or office BP than an optimized antihypertensive drug treatment at 6 and 12 months. However, among RH patients with higher baseline SBP, RDN might be more effective in reducing SBP.http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=13;spage=1586;epage=1594;aulast=ChenAntihypertensive Treatment; Hypertension; Randomized Controlled Trials; Renal Denervation; Subgroup Meta-analysis |
| spellingShingle | Xiao-Han Chen Sehee Kim Xiao-Xi Zeng Zhi-Bing Chen Tian-Lei Cui Zhang-Xue Hu Yi Li Ping Fu Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis Chinese Medical Journal Antihypertensive Treatment; Hypertension; Randomized Controlled Trials; Renal Denervation; Subgroup Meta-analysis |
| title | Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis |
| title_full | Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis |
| title_fullStr | Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis |
| title_full_unstemmed | Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis |
| title_short | Account for Clinical Heterogeneity in Assessment of Catheter-based Renal Denervation among Resistant Hypertension Patients: Subgroup Meta-analysis |
| title_sort | account for clinical heterogeneity in assessment of catheter based renal denervation among resistant hypertension patients subgroup meta analysis |
| topic | Antihypertensive Treatment; Hypertension; Randomized Controlled Trials; Renal Denervation; Subgroup Meta-analysis |
| url | http://www.cmj.org/article.asp?issn=0366-6999;year=2017;volume=130;issue=13;spage=1586;epage=1594;aulast=Chen |
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