The Current Status of Renal Denervation in Hypertension Management

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.