基于射频的肾脏去神经治疗对顽固性高血压患者的有效性和安全性:系统回顾与元分析》。

IF 3.1 Q2 PERIPHERAL VASCULAR DISEASE High Blood Pressure & Cardiovascular Prevention Pub Date : 2024-07-01 Epub Date: 2024-06-19 DOI:10.1007/s40292-024-00660-2
Luis Eduardo Rodrigues Sobreira, Fernando Baia Bezerra, Vitor Kendi Tsuchiya Sano, Artur de Oliveira Macena Lôbo, Jorge Henrique Cavalcanti Orestes Cardoso, Francinny Alves Kelly, Francisco Cezar Aquino de Moraes, Fernanda Marciano Consolim-Colombo
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引用次数: 0

摘要

导言:目的:了解射频 RDN 与药物治疗 RH 的安全性和有效性:在 PubMed、EMBASE 和 Cochrane 数据库中进行了全面的文献检索,重点是比较射频 RDN 与药物治疗 RH 效果的研究。对二元终点和连续终点的治疗效果进行了汇总,并分别使用几率比(OR)和平均差(MD)及95%置信区间(CI)来分析连续结果:纳入的 10 项研究共涉及 1 182 名患者,其中 682 人接受了基于射频的 RDN 治疗。随访时间从 6 个月到 84 个月不等。分析显示,RDN 组显著降低了诊室收缩压(MD - 9.5 mmHg;95% CI - 16.81 至 - 2.29;P = 0.01)、诊室舒张压(MD - 5.1 mmHg;95% CI - 8.42 至 - 2.80;P < 0.001)和 24 小时收缩压(MD - 4.8 mmHg;95% CI - 7.26 至 - 2.42;P < 0.001)。对于 24 小时舒张压,RDN 没有显著降低(MD - 2.3 mmHg; 95% CI - 4.19 to - 0.52; P = 0.012)。研究之间的异质性很高,这在漏斗图和鲍贾特图中都能看到。非严重不良事件的OR不显著,但RDN组的高血压危象和中风的OR具有临床意义:尽管包括利尿剂在内的 3 种或 3 种以上抗高血压药物治疗方案仍是 RH 治疗的一线选择,但我们的研究结果表明,基于射频的 RDN 在降低总体血压方面更具优势,而且是安全的。
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Efficacy and Safety of Radiofrequency-Based Renal Denervation on Resistant Hypertensive Patients: A Systematic Review and Meta-analysis.

Introduction: New therapies for resistant hypertension (RH), including renal denervation (RDN), have been studied.

Aim: Access the safety and effectiveness of radiofrequency-based RDN vs pharmacological treatment for RH.

Methods: A thorough literature search was conducted across PubMed, EMBASE, and the Cochrane databases, focusing on studies that compared the effects of radiofrequency-based RDN versus pharmacological treatment for RH. Treatment effects for binary and continuous endpoints were pooled and used, respectively, odds-ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) to analyze continuous outcomes.

Results: In the 10 included studies, involving 1.182 patients, 682 received radiofrequency-based RDN. The follow-up period ranged from 6 to 84 months. Analysis revealed that the RDN group had a significant reduction in office systolic blood pressure (BP) (MD - 9.5 mmHg; 95% CI - 16.81 to - 2.29; P = 0.01), office diastolic BP (MD - 5.1 mmHg; 95% CI - 8.42 to - 2.80; P < 0.001), 24 h systolic BP (MD - 4.8 mmHg; 95% CI - 7.26 to - 2.42; P < 0.001). For 24 h diastolic BP RDN did not have a significant reduction (MD - 2.3 mmHg; 95% CI - 4.19 to - 0.52; P = 0.012). The heterogeneity between the studies was high, visible in the funnel and Baujat plots. The OR was non-significant for non-serious adverse events, but also clinically significant for hypertensive crises and strokes for the RDN group.

Conclusions: While the pharmacological regimen of 3 or more anti-hypertensive, including a diuretic, still be the first-line option for RH treatment, our results support that radiofrequency-based RDN is superior in reducing global BP and is safe.

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来源期刊
CiteScore
5.70
自引率
3.30%
发文量
57
期刊介绍: High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes:   Invited ''State of the Art'' reviews.  Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.
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