Selective Renal Artery Branch vs. Conventional Main Artery Denervation in Treatment-Resistant Hypertension: A Systematic Review and Meta-Analysis

Abstract

Introduction: Treatment-resistant hypertension affects over 500 million people globally, yet only 23% of hypertensive individuals achieve adequate control. Renal nerve denervation (RDN) has emerged as a promising adjunctive therapy. This systematic review and meta-analysis compares the efficacy of selective renal artery branch RDN versus conventional main renal artery RDN in lowering blood pressure.

Objectives: To compare selective renal artery branch denervation versus conventional main renal artery denervation in achieving optimal blood pressure control.

Material and Methods: In accordance with PRISMA guidelines, a systematic search of four databases—PubMed, EMBASE, Scopus, and ClinicalTrials.gov —was conducted to identify randomized controlled trials and observational studies comparing selective renal artery branch denervation with main renal artery denervation. The primary outcomes included office systolic blood pressure (SBP) at the 6-month primary endpoint and daytime and nighttime ambulatory blood pressure parameters. Statistical analyses were performed using R (version 2025.05.0+496), with statistical significance defined as a two-tailed p-value < 0.05.

Results: Among four studies enrolling 488 patients, 204 were in the selective renal artery RDN group and 376 in the conventional main renal artery RDN group. Selective renal artery RDN significantly reduced office systolic blood pressure (SBP) compared to conventional RDN (MD −4.04 mmHg; 95% CI: −6.59 to −1.49; p = 0.0019). Significant reductions were also observed in daytime ambulatory SBP (MD −7.96 mmHg; 95% CI: −13.35 to −2.56; p = 0.0039), daytime diastolic BP (DBP) (MD −4.09 mmHg; 95% CI: −7.32 to −0.87; p = 0.0126), and nighttime SBP (MD −9.82 mmHg; 95% CI: −12.88 to −6.77; p < 0.0001), all favoring the selective renal artery RDN group. Heterogeneity was substantial for office SBP (I² = 82.1%) but minimal for all ambulatory BP outcomes (I² ≤ 8.5%).

Conclusion: Selective renal artery branch RDN is more effective in reducing office and ambulatory blood pressure than conventional main renal artery RDN. These findings highlight selective RDN as a promising treatment option for patients with resistant hypertension, offering better blood pressure control, in light of recent RDN FDA approval. Head-to-head RCTs with extended follow-ups are warranted to validate these results further.

Keywords: Renal Denervation; Hypertension; Ambulatory Blood Pressure Monitoring; Catheter Ablation; Treatment-Resistant Hypertension