Renal Denervation in Modern Hypertension Care: From Early Promise to Evidence-Based Clinical Integration

Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and mortality. However, rates of global blood pressure (BP) control remain suboptimal, despite effective pharmacologic therapies and clear guideline targets. Persistent gaps in control are multifactorial, including poor adherence, complex treatment regimens, and health care system limitations. Renal denervation (RDN), a device-based therapy, is an emerging treatment which may overcome barriers for hypertension control. RDN targets renal sympathetic nerve activity, a key contributor to hypertension pathophysiology. Early studies of RDN, using catheter-based ablation techniques, suggested substantial BP reductions (∼10-30 mmHg reduction in office systolic BP). However, initial enthusiasm was tempered by neutral findings in sham-controlled trials. Recent advances in device technology, procedural optimization, technique, and patient selection have been central to improving reproducibility and redemonstrating efficacy (office and ambulatory BP) and safety of RDN in contemporary randomized studies. Current evidence supports RDN as an adjunctive therapy in carefully selected patients with resistant or uncontrolled primary hypertension, particularly in those with preserved renal function and evidence of sympathetic overactivity. As the field evolves, ongoing research focusing on precision phenotyping, noncatheter-based techniques, long-term clinical outcomes, and cost-effectiveness will be critical in defining the role of RDN within contemporary hypertension management strategies.