Long-term effects of renal denervation on hypertension management: insights from a center of excellence

Background/Introduction Renal denervation (RDN) has been approved in recent guidelines as the third pillar for the management of resistant or uncontrolled hypertension. Purpose The aim of this study was to evaluate the long-term outcomes of radiofrequency (RF) RDN in a cohort of patients treated at an ESH center of excellence, with a mean follow-up of 8 years. Methods From a pool of patients with uncontrolled hypertension who had previously undergone RF RDN, we included those with a follow-up longer than 3 years (n=97). Baseline and follow-up data were collected for each patient, including office blood pressure (OBP), ambulatory blood pressure (ABP), use of antihypertensive medication, and markers of renal function. A propensity-matched control group of patients with resistant hypertension managed conservatively (without RDN) was selected for comparison. All-cause mortality and non-fatal cardiovascular events were recorded. Results A total of 76 patients (mean age 61.4±10.5 years, 25% female) had follow-up data over a mean of 8.3±3.4 years. OBP decreased significantly from baseline by 21.8±16.9 mmHg systolic and 13.1±9.6 mmHg diastolic (p<0.001 for both). In 41 patients with ABP data, systolic ABP decreased by 19.4±13.1 mmHg and diastolic ABP by 12.7±10.0 mmHg (p<0.001 for both). The number of prescribed antihypertensive medications was reduced by 0.54±1.2 (p<0.01). By the end of follow-up, 9 of the 97 RDN patients (9.3%) had died, compared with 5 of 44 control patients (11.4%) over a mean follow-up of 8.1±2.3 years. Twelve patients were lost to follow-up. Estimated glomerular filtration rate declined significantly in the RDN group from 83.0±14.4 to 75.5±19.2 mL/min/1.73 m² (p<0.001). Conclusion(s) RDN is a safe procedure that provides durable antihypertensive effects lasting for at least 8 years.