Patient-Level Pooled Analysis of Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials

This systematic review and meta-analysis investigates the consistency of blood pressure reduction observed with ultrasound renal denervation compared with sham across studies of varying hypertension severity. Key PointsQuestionIs the magnitude of blood pressure (BP) reduction observed with ultrasound renal denervation (uRDN) compared with a sham procedure consistent across studies of varying hypertension severity? FindingsIn this patient-level pooled analysis of 3 randomized clinical trials including 506 patients with varying severities of hypertension, the reduction in daytime ambulatory systolic BP was significantly greater among patients receiving uRDN compared with sham at 2 months, with consistency across trials. MeaninguRDN reduces BP compared with a sham procedure. ImportanceUltrasound renal denervation (uRDN) was shown to lower blood pressure (BP) in patients with uncontrolled hypertension (HTN). Establishing the magnitude and consistency of the uRDN effect across the HTN spectrum is clinically important. ObjectiveTo characterize the effectiveness and safety of uRDN vs a sham procedure from individual patient-level pooled data across uRDN trials including either patients with mild to moderate HTN on a background of no medications or with HTN resistant to standardized triple-combination therapy. Data SourcesA Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN SOLO and TRIO) and A Study of the ReCor Medical Paradise System in Stage II Hypertension (RADIANCE II) trials. Study SelectionTrials with similar designs, standardized operational implementation (medication standardization and blinding of both patients and physicians to treatment assignment), and follow-up. Data Extraction and SynthesisPooled analysis using individual patient-level data using linear regression models to compare uRDN with sham across the trials. Main Outcomes and MeasuresThe primary outcome was baseline-adjusted change in 2-month daytime ambulatory systolic BP (dASBP) between groups. ResultsA total of 506 patients were randomized in the 3 studies (uRDN, 293; sham, 213; mean [SD] age, 54.1 [9.3]; 354 male [70.0%]). After a 1-month medication stabilization period, dASBP was similar between the groups (mean [SD], uRDN, 150.3[9.2] mm Hg; sham, 150.8[10.5] mm Hg). At 2 months, dASBP decreased by 8.5 mm Hg to mean (SD) 141.8(13.8) mm Hg among patients treated with uRDN and by 2.9 mm Hg to 147.9(14.6) mm Hg among patients treated with a sham procedure (mean difference, -5.9; 95% CI, -8.1 to -3.8 mm Hg; P<.001 in favor of uRDN). BP decreases from baseline with uRDN vs sham were consistent across trials and across BP parameters (office SBP: -10.4 mm Hg vs -3.4 mm Hg; mean difference, -6.4 mm Hg; 95% CI, -9.1 to -3.6 mm Hg; home SBP: -8.4 mm Hg vs -1.4 mm Hg; mean difference, -6.8 mm Hg; 95% CI, -8.7 to -4.9 mm Hg, respectively). The BP reductions with uRDN vs sham were consistent across prespecified subgroups. Independent predictors of a larger BP response to uRDN were higher baseline BP and heart rate and the presence of orthostatic hypertension. No differences in early safety end points were observed between groups. Conclusions and RelevanceResults of this patient-level pooled analysis suggest that BP reductions with uRDN were consistent across HTN severity in sham-controlled trials designed with a 2-month primary end point to standardize medications across randomized groups. Trial RegistrationClinicalTrials.gov Identifier: NCT02649426 and NCT03614260

Automated summary

This systematic review and meta-analysis found consistent blood pressure reductions with ultrasound renal denervation compared to sham across studies of varying hypertension severity. The reductions were greater in patients receiving renal denervation and were consistent across trials and different blood pressure parameters. Renal denervation is an important intervention for hypertensive patients.