Key result
Renal denervation reduces office systolic blood pressure by ~7 mm Hg versus sham.
Why the study?
Fewer than one in four treated adults with hypertension achieves guideline-recommended blood pressure targets, despite hypertension being the leading modifiable cause of cardiovascular death.
Does catheter-based renal denervation reduce blood pressure in adults with uncontrolled and resistant hypertension?
Does catheter-based renal denervation reduce blood pressure in adults with uncontrolled and resistant hypertension?
Mean Difference: 6.6 (95% CI 3.6–9.7)
Catheter-based renal denervation offers a safe, durable, and adherence-independent reduction in blood pressure for patients with uncontrolled hypertension, now supported by robust sham-controlled evidence and clinical guidelines.
Supports renal denervation consideration in resistant hypertension; extends second-generation sham-controlled data beyond initial neutral trials.
Hypertension remains the leading modifiable cause of cardiovascular death, yet fewer than one in four treated adults achieves guideline-recommended blood pressure targets. Catheter-based renal denervation interrupts efferent and afferent renal sympathetic signalling and lowers blood pressure continuously and independently of medication adherence. After a decade of controversy following the neutral SYMPLICITY HTN-3 trial, a coherent body of second-generation sham-controlled randomised evidence, generated with radiofrequency, endovascular ultrasound, and perivascular alcohol platforms, has established a reproducible, modest, and durable antihypertensive effect with a favourable safety profile. Between 2024 and 2026, the field crossed three thresholds simultaneously: guideline endorsement on both sides of the Atlantic, including the first United States recommendation in the 2025 AHA/ACC guideline; a national coverage determination with coverage with evidence development; and the maturation of randomised and real-world follow-up to three years in cohorts exceeding 3000 patients. This state-of-the-art review synthesises the contemporary evidence base; quantifies the expected treatment effect and its heterogeneity; appraises safety across renal and vascular domains; examines emerging data in chronic kidney disease, diabetes, heart failure, and atrial fibrillation; and details the practical requirements for delivering renal denervation responsibly. We conclude by defining the research agenda that must now be addressed: the identification of responders, the development of an intraprocedural endpoint, a direct comparison with newly approved pharmacotherapy, and evidence of cardiovascular event reduction.
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Skalidis et al. (2026) conducted a review in Uncontrolled and resistant hypertension. Catheter-based renal denervation vs. Sham procedure or standard medical therapy was evaluated on Sham-corrected reduction in office systolic blood pressure (MD 6.6 mm Hg reduction, 95% CI 3.6 to 9.7). Catheter-based renal denervation provides a reproducible and durable sham-corrected reduction of 6.6 mm Hg in office systolic blood pressure and 4.4 mm Hg in 24-hour ambulatory systolic blood pressure.
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