Abstract

Research Article

The Current Status of Renal Denervation in Hypertension Management

Anil Avci*, Regaip Zehir and Mehmet Kaan Kirali

Published: 05 August, 2025 | Volume 9 - Issue 1 | Pages: 015-017

Introduction: Hypertension is still one of the major causes of cardiovascular disease and death worldwide. Despite lifestyle modifications and medical treatment, blood pressure control rates remain suboptimal. The sympathetic nervous system plays a significant role in the pathophysiology of hypertension. Inhibition of the sympathetic nervous system leads to a reduction in blood pressure. In light of this, a catheter-based renal denervation procedure has been developed to selectively ablate the renal sympathetic nerves in order to lower blood pressure. 
Discussion: Renal denervation targets the afferent and efferent sympathetic nerves along the renal arteries. Interruption of the renal nerve fibers in the perivascular space reduces sympathetic-mediated renal vascular resistance, renin release, and sodium reabsorption. Consequently, the mechanisms driving systemic hypertension are gradually disrupted, and blood pressure falls over time. The current main methods of renal denervation are radiofrequency energy, ultrasound, and perivascular neurotoxin injection. Recent randomized sham-controlled trials have shown that renal denervation effectively and safely reduces blood pressure by approximately 5 to 10 mmHg in various hypertensive patients. It is important to have a multidisciplinary team of hypertension specialists and interventional experts to select appropriate patients for renal denervation. Shared decision-making is essential to consider hypertension-mediated organ damage, cardiovascular risk, and patient preferences. 
Conclusion: Catheter-based renal denervation is a relatively new treatment modality that provides meaningful and sustained reductions in blood pressure with an acceptable safety profile. Currently, it is recommended for patients with uncontrolled or resistant hypertension despite optimal lifestyle changes and medical treatment.

Read Full Article HTML DOI: 10.29328/journal.ach.1001039 Cite this Article Read Full Article PDF

Keywords:

Hypertension; Cardiovascular risk; Renal denervation

References

  1. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874–2071. Available from: https://doi.org/10.1097/hjh.0000000000003480
  2. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912–4018. Available from: https://doi.org/10.1093/eurheartj/ehae178
  3. Cluett JL, Blazek O, Brown AL, East C, Ferdinand KC, Fisher NDL, et al. Renal Denervation for the Treatment of Hypertension: A Scientific Statement From the American Heart Association. Hypertension. 2024;81(10):e135–e148. Available from: https://doi.org/10.1161/HYP.0000000000000240
  4. Kandzari DE, Townsend RR, Bakris G, Basile J, Bloch MJ, Cohen DL, et al. Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF. Catheter Cardiovasc Interv. 2021;98(3):416–426. Available from: https://doi.org/10.1002/ccd.29884
  5. Rey-García J, Townsend RR. Renal Denervation: A Review. Am J Kidney Dis. 2022;80(4):527–535. Available from: https://doi.org/10.1053/j.ajkd.2022.03.015
  6. Tung M, Kobayashi T, Swaminathan RV, Cohen DL, Feldman DN, Fulton B. Renal Denervation: A Review of Current Devices, Techniques, and Evidence. Interv Cardiol Clin. 2025;14(2):225–234. Available from: https://doi.org/10.1016/j.iccl.2024.11.008
  7. Townsend RR, Mahfoud F, Kandzari DE, Kario K, Pocock S, Weber MA, et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017;390(10108):2160–2170. Available from: https://doi.org/10.1016/s0140-6736(17)32281-x
  8. Kandzari DE, Böhm M, Mahfoud F, Townsend RR, Weber MA, Pocock S, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet. 2018;391(10137):2346–2355. Available from: https://doi.org/10.1016/s0140-6736(18)30951-6
  9. Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Davies J, et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial. Lancet. 2018;391(10137):2335–2345. Available from: https://doi.org/10.1016/s0140-6736(18)31082-1
  10. Azizi M, Saxena M, Wang Y, Jenkins JS, Devireddy C, Rader F, et al. Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial. JAMA. 2023 Feb 28;329(8):651–661. Available from: https://doi.org/10.1001/jama.2023.0713
  11. Azizi M, Sanghvi K, Saxena M, Gosse P, Reilly JP, Levy T, et al. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial. Lancet. 2021;397(10293):2476–2486. Available from: https://doi.org/10.1016/s0140-6736(21)00788-1
  12. Azeez GA, Thirunagari M, Fatima N, Anand A, Palvia AR, Kaur A, et al. The Efficacy of Renal Denervation in Treating Resistant Hypertension: A Systematic Review. Cureus. 2024;16(8):e67007. Available from: https://doi.org/10.7759/cureus.67007
  13. Esler MD, Osborn JW, Schlaich MP. Sympathetic Pathophysiology in Hypertension Origins: The Path to Renal Denervation. Hypertension. 2024;81(6):1194–1205. Available from: https://doi.org/10.1161/hypertensionaha.123.21715
  14. Marcusohn E, Tobe SW, Dueck A, Madan M. Renal denervation for uncontrolled hypertension. CMAJ. 2023;195(43):E1475–E1480. Available from: https://pubmed.ncbi.nlm.nih.gov/37931951/
  15. Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393–1401. Available from: https://doi.org/10.1056/nejmoa1402670
  16. Maini AS, Maini M, Addo T, Koshti V, Koshy T, de Lemos JA, et al. The current state and future of renal denervation: A review. Trends Cardiovasc Med. 2025;35(2):96–104. Available from: https://doi.org/10.1016/j.tcm.2024.08.005
  17. Böhm M, Kario K, Kandzari DE, Mahfoud F, Weber MA, Schmieder RE, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial. Lancet. 2020;395(10234):1444–1451. Available from: https://doi.org/10.1016/s0140-6736(20)30554-7
  18. Mahfoud F, Böhm M, Schmieder R, Narkiewicz K, Ewen S, Ruilope L, et al. Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the Global SYMPLICITY Registry. Eur Heart J. 2019;40(42):3474–3482. Available from: https://doi.org/10.1093/eurheartj/ehz118
  19. Bhatt DL, Vaduganathan M, Kandzari DE, Leon MB, Rocha-Singh K, Townsend RR, et al. Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial. Lancet. 2022;400(10361):1405–1416. Available from: https://doi.org/10.1016/s0140-6736(22)01787-1
  20. Mahfoud F, Kandzari DE, Kario K, Townsend RR, Weber MA, Schmieder RE, et al. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial. Lancet. 2022;399(10333):1401–1410. Available from: https://doi.org/10.1016/S0140-6736(22)00455-X
  21. Rader F, Kirtane AJ, Wang Y, Daemen J, Lurz P, Sayer J, et al. Durability of blood pressure reduction after ultrasound renal denervation: three-year follow-up of the treatment arm of the randomised RADIANCE-HTN SOLO trial. EuroIntervention. 2022;18(8):e677–e685. Available from: https://doi.org/10.4244/eij-d-22-00305
  22. Al Ghorani H, Kulenthiran S, Recktenwald MJM, Lauder L, Kunz M, Götzinger F, et al. 10-Year Outcomes of Catheter-Based Renal Denervation in Patients With Resistant Hypertension. J Am Coll Cardiol. 2023;81(5):517–519. Available from: https://doi.org/10.1016/j.jacc.2022.11.038
  23. Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2023;44(15):1313–1330. Available from: https://europepmc.org/article/MED/37285272
  24. Schmieder R, Burnier M, East C, Tsioufis K, Delaney S. Renal Denervation: A Practical Guide for Health Professionals Managing Hypertension. Interv Cardiol. 2023;18:e06. Available from: https://doi.org/10.15420/icr.2022.38

Figures:

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?