Evidence map›Paper›PMID 29752703›Full record

SynthesisHigh blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension2018

Effectiveness of Renal Denervation in Resistant Hypertension: A Meta-Analysis of 11 Controlled Studies.

Marco Pappaccogli, Michele Covella, Elena Berra, Chiara Fulcheri, Silvia Di Monaco, Elisa Perlo, Jacopo Burrello, Silvia Monticone, Denis Rossato, Franco Rabbia and 1 more

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 2 pooled it
2.9field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Review
  6. Review
  7. New Aspects in the Management of Hypertension in Patients with Chronic Kidney Disease not on Renal Replacement Therapy.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2022
    Review
  8. Treatment-resistant hypertension assessed by home blood pressure monitoring: a new target for intervention?Hypertension research : official journal of the Japanese Society of Hypertension · 2022
    Article
  9. Device-based therapies for arterial hypertension.Nature reviews. Cardiology · 2020
    Review
  10. Article
  11. Catheter-Based Renal Denervation for Hypertension.Current hypertension reports · 2018
    Review
  12. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 2 countries.

Marco PappaccogliDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy. marcopappaccogli90@gmail.com.ORCID http://orcid.org/0000-0003-4107-8122
Michele CovellaDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Elena BerraDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Chiara FulcheriDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Silvia Di MonacoDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Elisa PerloDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Jacopo BurrelloDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Silvia MonticoneDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Denis RossatoRadiology Unit, Città della Salute e della Scienza, Department of Medical Sciences, University of Turin, Turin, Italy.
Franco RabbiaDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
Franco VeglioDivision of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Via Genova 3, 10126, Turin, Italy.
University of Turin · ITDepartment of Medical Sciences · BY

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionEarly uncontrolled studies reported large blood pressure reductions in subjects with resistant hypertension treated with renal denervation, however these results were not confirmed in several of the latest publications.

aimThe aim of the current study was to evaluate the effectiveness of RDN in controlled studies comparing RDN to either a sham procedure or to medical therapy.

methodOnly controlled studies were included in the analysis. Both the unadjusted and control-adjusted BP changes were calculated.

resultsWe identified 11 publications of which only 3 were double-blinded RCTs with a sham control, while 8 were open label studies where the control group was treated with medical therapy. Only 2 studies assessed adherence to medical therapy with robust methodologies. Office BP reduction (- 18/8 mmHg) significantly overestimated ABPM change (- 9/- 5 mmHg), with high heterogeneity between the included studies. When the treatment effect was adjusted for the BP change in the control group, BP changes became non significant (ABPM: - 1.8 for systolic BP [95% CI - 4.5 to 0.9] and - 0.6 for diastolic BP [95% CI - 2.3 to 1.2]). These results were confirmed when only the sham-controlled studies were analysed.

conclusionsIn spite of promising results in early reports, renal denervation fails to show superiority to a sham procedure or to medical therapy in recently published controlled studies. Lack of a sham control in most publications and heterogeneity in assessment of treatment adherence may account for part the variability reported in the studies. Renal denervation fails to show superiority to a sham procedure or to medical therapy in recently published controlled studies.

Indexed as

Blood PressureAntihypertensive AgentsDrug ResistanceHumansHypertensionKidneyRandomized Controlled Trials as TopicRenal ArteryRisk FactorsSympathectomyTreatment OutcomeAntihypertensive AgentsDrug adherenceHypertensionInvasive therapyMeta-analysisRenal denervationResistant hypertension

Identifiers

PMID29752703
OpenAlexW2799844971

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.