Renal denervation in internal medicine: a FADOI Position Paper on behalf of the Vicenza Hypertension Multidisciplinary Team. Endorsed by the Italian Society of Arterial Hypertension

Resistant hypertension (RH) remains a clinical challenge in internal medicine, associated with increased cardiovascular morbidity and mortality. Renal denervation (RDN), a catheter-based intervention targeting renal sympathetic nerves, has re-emerged as a promising “adjunctive” therapy following the publication of the latest sham-controlled randomized trials. Current data demonstrate that RDN provides a modest but consistent reduction in blood pressure, with a favorable safety profile in selected patients with RH and uncontrolled hypertension, despite optimized pharmacological therapy or in those with medication intolerance. This paper reviews the pathophysiological rationale, updated clinical evidence, patient selection criteria, procedural aspects, and future perspectives of RDN, for which a multidisciplinary approach is required to ensure procedural safety and optimal outcomes. This position paper is not intended to be a new guideline but a practical recommendation on how to proceed with the selection of the patient candidate for RDN and his management before and after the procedure in internal medicine coordinated by a hypertension specialist.