We did a subject-level meta-analysis of the changes (Δ) in blood pressure (BP) observed 3 and 6 months after renal denervation (RDN) at 10 European centers. Recruited patients (n=109; 46.8% women; mean age 58.2 years) had essential hypertension confirmed by ambulatory BP. From baseline to 6 months, treatment score declined slightly from 4.7 to 4.4 drugs per day. Systolic/diastolic BP fell by 17.6/7.1 mm Hg for office BP, and by 5.9/3.5, 6.2/3.4, and 4.4/2.5 mm Hg for 24-h, daytime and nighttime BP (P0.03 for all). In 47 patients with 3- and 6-month ambulatory measurements, systolic BP did not change between these two time points (P0.08). Normalization was a systolic BP of <140 mm Hg on office measurement or <130 mm Hg on 24-h monitoring and improvement was a fall of 10 mm Hg, irrespective of measurement technique. For office BP, at 6 months, normalization, improvement or no decrease occurred in 22.9, 59.6 and 22.9% of patients, respectively; for 24-h BP, these proportions were 14.7, 31.2 and 34.9%, respectively. Higher baseline BP predicted greater BP fall at follow-up; higher baseline serum creatinine was associated with lower probability of improvement of 24-h BP (odds ratio for 20-μmol l(-1) increase, 0.60; P=0.05) and higher probability of experiencing no BP decrease (OR, 1.66; P=0.01). In conclusion, BP responses to RDN include regression-to-the-mean and remain to be consolidated in randomized trials based on ambulatory BP monitoring. For now, RDN should remain the last resort in patients in whom all other ways to control BP failed, and it must be cautiously used in patients with renal impairment.

] Pole of Cardiovascular Research Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium [2] Division of Cardiology Cliniques Universitaires Saint Luc Université Catholique de Louvain Brussels Belgium

] Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Leuven Belgium [2] Department of Epidemiology Maastricht University Maastricht The Netherlands

3rd Department of Internal Medicine General Faculty Hospital Prague Czech Republic

BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK

Department of Cardiology Isala Klinieken Zwolle The Netherlands

Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden

Department of Cardiology Ullevål University Hospital University of Oslo Oslo Norway

Division of Cardiovascular Medicine Department of Clinical Sciences Danderyd Hospital Karolinska Institute Stockholm Sweden

Faculté de Médecine Université Paris Descartes Paris France

Hypertension Unit Geneva University Hospital Geneva Switzerland

Pole of Cardiovascular Research Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium

Service of Nephrology Lausanne University Hospital Lausanne Switzerland

Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Leuven Belgium

J Clin Hypertens (Greenwich). 2014 Feb;16(2):91-3. doi: 10.1111/jch.12215. PubMed

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