Renal Denervation in a Patient With Resistant Hypertension Using a Second-Generation Multi-electrode Catheter in Puerto Rico: A Non-pharmacological Technique for Resistant Arterial Hypertension

Resistant arterial hypertension poses a clinical challenge, often requiring novel interventions beyond pharmacologic therapy. Renal denervation (RDN), a catheter-based technique targeting renal sympathetic nerves, has emerged as a promising adjunctive treatment. A 44-year-old female with resistant hypertension, unresponsive to triple antihypertensive therapy (clonidine 0.2 mg orally twice a day, losartan 100 mg orally daily, and hydrochlorothiazide 25 mg orally daily), presented with hypertensive urgency (blood pressure: 180/109 mmHg). Secondary causes of hypertension were excluded. She underwent bilateral renal denervation using the Symplicity Spyral second-generation radiofrequency catheter (Medtronic, Minneapolis, MN, US). Given persistently elevated blood pressure despite guideline-directed medical therapy and no secondary etiology, the multidisciplinary team opted for RDN. The procedure was performed via right femoral arterial access. A total of 33 ablations were applied (22 on the right renal artery, 11 on the left renal artery) with no procedural complications. This case represents the first documented RDN in Puerto Rico using a second-generation multi-electrode system. The patient achieved blood pressure control by day 3 post-procedure, maintained at the three-month follow-up without major medication changes or adverse events. RDN offers a safe, effective, and minimally invasive strategy for managing resistant hypertension in selected patients.