肾脏去神经化--射频与超声：随机假对照试验混合治疗比较荟萃分析的启示。

IF 3.3 2区医学 Q1 PERIPHERAL VASCULAR DISEASE Journal of Hypertension Pub Date : 2024-10-18 DOI:10.1097/HJH.0000000000003909

Sripal Bangalore, M Haisum Maqsood, George L Bakris, Sunil V Rao, Franz H Messerli

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引用次数: 0

摘要

背景和目的：多项随机试验表明，与假对照相比，肾脏去神经（RDN）可降低血压（BP），但射频RDN与超声RDN的降压疗效尚不确定。我们的目的是比较高血压患者接受射频肾小管扩张术（rRDN）和超声肾小管扩张术（uRDN）与假对照的疗效：在PubMed、EMBASE和clinicaltrials.gov数据库中搜索了rRDN或uRDN的随机假对照试验（RCT），或rRDN与uRDN的对比试验。主要疗效结果为 24 小时动态 SBP。研究人员进行了一项混合治疗比较荟萃分析，比较了假治疗和相互治疗的疗效和安全性：结果：在纳入 2285 名高血压患者的 13 项研究中，与假治疗相比，rRDN 可降低 24 小时非卧床 SBP[（MD = 2.34 mmHg；95% 置信区间（95% CI）：0.72-3.95]、诊室 SBP（MD = 5.04 mmHg；95% CI：2.68-7.40）]和诊室 DBP（MD = 2.95 mmHg；95% CI：1.68-4.22）。同样，与假体相比，uRDN 可降低 24 小时非卧床 SBP（MD = 4.74 mmHg；95% CI：2.80-6.67）、日间非卧床 SBP（MD = 5.40 mmHg；95% CI：3.68-7.13）、夜间非卧床 SBP（MD = 3.84 mmHg；95% CI：0.02-7.67）和办公室 SBP（3.98 mmHg；95% CI：0.78-7.19）。与 rRDN 相比，uRDN 可明显降低 24 小时非卧床 SBP（MD = 2.40 mmHg；95% CI：0.09-4.71）、日间非卧床 SBP（MD = 4.09 mmHg；95% CI：1.61-6.56）和夜间非卧床 SBP（MD = 5.76 mmHg；95% CI：0.48-11.0）。在主要疗效方面，uRDN排名第一，其次是rRDN（第二）和假体（第三）：结论：在高血压患者中，与假对照组相比，rRDN 和 uRDN 能显著降低 24 小时非卧床血压和办公室血压，在随访 4 个月（平均值）时，uRDN 对非卧床血压的降低幅度明显高于 rRDN。有必要对 rRDN 或 uRDN 进行大规模的头对头随机试验，以评估其疗效是否存在差异。

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Renal denervation - radiofrequency vs. ultrasound: insights from a mixed treatment comparison meta-analysis of randomized sham controlled trials.

Background and aims: Multiple randomized trials have shown that renal denervation (RDN) reduces blood pressure (BP) when compared with sham control but the antihypertensive efficacy of radiofrequency vs. ultrasound-based RDN is uncertain. We aimed to compare the outcomes of radiofrequency RDN (rRDN) and ultrasound RDN (uRDN), when compared with sham in patients with hypertension.

Methods: PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized sham-controlled trials (RCTs) of rRDN or uRDN or for trials of rRDN vs. uRDN. Primary efficacy outcome was 24-h ambulatory SBP. A mixed treatment comparison meta-analysis was performed comparing the efficacy and safety against sham and against each other.

Results: Among 13 RCTs that enrolled 2285 hypertensive patients, rRDN reduced 24-h ambulatory SBP [(MD = 2.34 mmHg; 95% confidence interval (95% CI): 0.72-3.95], office SBP (MD = 5.04 mmHg; 95% CI: 2.68-7.40)], and office DBP (MD = 2.95 mmHg; 95% CI: 1.68-4.22) when compared with sham. Similarly, uRDN reduced 24-h ambulatory SBP (MD = 4.74 mmHg; 95% CI: 2.80-6.67), day-time ambulatory SBP (MD = 5.40 mmHg; 95% CI: 3.68-7.13), night-time ambulatory SBP (MD = 3.84 mmHg; 95% CI: 0.02-7.67), and office SBP (3.98 mmHg; 95% CI: 0.78-7.19) when compared with sham. There was significantly greater reduction in 24-h ambulatory SBP (MD = 2.40 mmHg; 95% CI: 0.09-4.71), day-time ambulatory SBP (MD = 4.09 mmHg; 95% CI: 1.61-6.56), and night-time ambulatory SBP (MD = 5.76 mmHg; 95% CI: 0.48-11.0) with uRDN when compared with rRDN. For primary efficacy outcome, uRDN ranked #1, followed by rRDN (#2), and sham (#3).

Conclusion: In hypertensive patients, rRDN and uRDN significantly reduced 24-h ambulatory and office SBP when compared with sham control with significantly greater reduction in ambulatory BP with uRDN than with rRDN at 4 months (mean) of follow-up. A large-scale randomized head-to-head trial of rRDN or uRDN is warranted to evaluate if there are differences in efficacy.

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来源期刊

Journal of Hypertension 医学-外周血管病

CiteScore

7.90

自引率

6.10%

发文量

1389

审稿时长

3 months

期刊介绍： The Journal of Hypertension publishes papers reporting original clinical and experimental research which are of a high standard and which contribute to the advancement of knowledge in the field of hypertension. The Journal publishes full papers, reviews or editorials (normally by invitation), and correspondence.