Renal denervation in high-risk patients with hypertension

Hypertension is a common health problem, which leads to a substantial mortality and morbidity burden, globally. The management of patients with high-risk and treatment-resistant hypertension remains a major clinical challenge to the treating physician. Renal denervation (RD) is an emerging technique, comprising modification of the renal sympathetic nerve supply which courses around the renal arteries. Endovascular access is obtained to the renal arteries, followed by delivery of heat energy to the peri-renal sympathetic nerves. This leads to the reduction of blood pressure with or without the addition of anti-hypertensive pharmacotherapy. Earlier trials led to clinical equipoise, but more recent trials (e.g. SPYRAL HTN-OFF MED, SPYRAL HTN-ON MED and RADIANCE-HTN SOLO), which were designed to overcome the limitations of the initial studies, have provided support for the efficacy of RD in hypertension management. Evidence (from randomised, non-randomised, sham-controlled and non-sham-controlled trials) for the use of RD in the treatment of hypertension is reviewed in this article. Finally, the current clinical role, gaps in evidence, and the expected future evolution of RD are discussed.