Renal denervation therapy for hypertension: still on trial

Hypertension remains the leading risk factor for death and disability worldwide1 and affects one in three adults in the UK. Despite current management, primarily focusing on lifestyle modification and pharmacological therapies, up to a third of patients do not reach current blood pressure (BP) targets. Treatment-resistant hypertension (TRH: defined as having a BP above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic) is common, affecting around 6%–8% of people with treated hypertension in the UK.2 The reasons for treatment failure are wide ranging but poor adherence is a very major factor.3 For this reason, a once-only therapy to reduce BP in the long term is a very attractive option. Renal denervation (RDN), as a treatment for hypertension, initially gained traction early this century. It is based on a sound pathophysiological understanding of hypertension and the role the sympathetic nervous system plays. Indeed, prior to the advent of modern antihypertensive therapies surgical sympathectomies were commonly used in the treatment of severe hypertension, although side effects were often intolerable.4 RDN differs from the earlier blunt approaches by directly targeting the renal sympathetic nerves, which are known to have an important role in regulating renal blood flow and sodium …