27. The Efficacy and Safety of Ultrasound Renal Denervation on Hypertensive Patients: A Systematic Review and Meta-Analysis of Clinical Cases

Introduction: The World Health Organization (WHO) recorded hypertension as the leading non-communicable disease case (77%) by 2021. Since the Renin-Angiotensin-Aldosterone System (RAAS) is implicated in the pathogenesis of primary hypertension, ultrasound-based renal denervation (URD) has proven effective as a future approach to improving systolic and diastolic blood pressure conditions. URD technology utilizes acoustic energy for circumferential ablation patterns while incorporating endovascular cooling through an irrigated balloon. Objectives: This study evaluates the efficacy and safety of URD in hypertension patients. Methods: The literature search was carried out through PubMed, ScienceDirect, BMJ Journals, and Google Scholar with a total of 643 articles. A total of 427 articles were screened and selected, resulting in 6 included studies. Quality appraisal was done using RoB 2.0, while meta-analysis used RevMan 5.4. Results: Our analysis included six studies assessing the efficacy and safety of a URD intervention for hypertension, results indicated significant improvements in 24-hour, daytime, and home ambulatory blood pressure measurements, favouring the URD over control. The mean difference (MD) for 24-hour measurements was -0.84 [95% CI -1.41; -0.55], for daytime measurements -1.27 [95% CI -1.59; -0.95], and for home measurements -1.87 [95% CI -2.21; -1.52], with moderate heterogeneity observed. Office ambulatory measurements also favoured the URD with a significant MD of -1.51 [95% CI -1.91; -1.10]. Funnel plots revealed some outliers, indicating true heterogeneity among the studies. Conclusion: URD was associated with a significant reduction in blood pressure in hypertensive patients across several settings, albeit with some variability between studies.