Clinical research progress of renal denervation for heart failure treatment: current evidence, controversies, and future directions

Heart failure (HF) management continues to evolve, yet morbidity and mortality remain high, particularly among patients with comorbid hypertension and heightened sympathetic activity. In this narrative review, we summarize the mechanistic rationale for renal sympathetic denervation (RDN) in HF, synthesize available clinical evidence across HF phenotypes, and highlight key controversies and future research priorities. We emphasize differential responses across geographic regions and consider how ongoing trials may refine patient selection, procedural strategies, and endpoints. As evidence grows, RDN may become an adjunct device-based therapy for selected HF patients, but definitive outcome trials are still needed before routine implementation.