Key result
Renal denervation lowers 24-hour ambulatory systolic BP by up to ~12 mmHg across sham-controlled trials.
Why the study?
Despite available antihypertensive drugs and lifestyle interventions, global blood pressure control rates are declining and resistant hypertension prevalence is rising. As renal denervation reemerges as a promising adjunctive therapy, its precise role as a last-resort treatment for resistant hypertension versus broader application in hypertensive patients requires clarification.
Does renal denervation reduce 24-hour ambulatory systolic blood pressure in patients with hypertension?
Does renal denervation reduce 24-hour ambulatory systolic blood pressure in patients with hypertension?
Answers are grounded in this paper and cite their sources.
Renal denervation has evolved into a guideline-endorsed, safe, and durable adjunctive therapy that reduces 24-hour ambulatory systolic blood pressure by 4.4–12.1 mm Hg, particularly benefiting patients with resistant hypertension, medication intolerance, or poor adherence.
Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and mortality worldwide. Despite the availability of numerous antihypertensive drugs and lifestyle interventions, global blood pressure (BP) control rates are declining, and the prevalence of resistant hypertension is rising. Renal denervation (RDN), a device-based intervention targeting renal sympathetic nerves, has reemerged as a promising adjunctive therapy due to its independence from patient adherence and its capacity for sustained sympathetic modulation. This review critically synthesizes mechanistic, clinical, and implementation evidence regarding RDN in hypertension management, aiming to clarify its precise role, whether as a last-resort therapy for resistant hypertension or as a candidate for broader application in hypertensive patients. Multiple large-scale, randomized, sham-controlled trials (e.g., SYMPLICITY HTN-3, SPYRAL HTN-ON MED, RADIANCE-HTN TRIO, RADIANCE II) have demonstrated that RDN reduces 24-hour ambulatory systolic BP by 4.4–12.1 mm Hg, with a favorable safety profile, both on and off antihypertensive medications. Long-term follow-up confirms the durability of BP reduction without significant renal impairment or major vascular complications. While RDN shows the greatest efficacy in resistant hypertension, clinically meaningful benefits are also observed in patients with mild-to-moderate hypertension, medication intolerance, or poor adherence. International guidelines (European Society of Cardiology 2024; American Heart Association/American College of Cardiology 2025; Japanese Society of Hypertension 2025) now endorse RDN as an adjunctive option for resistant hypertension. In Asian populations, RDN offers unique advantages in controlling nocturnal and morning hypertension. RDN has evolved from a “last resort” to a validated adjunct in hypertension management, particularly for patients with uncontrolled BP, poor adherence, or medication intolerance. Future directions should focus on optimizing patient selection, standardizing procedural protocols, and evaluating long-term cardiovascular outcomes to facilitate rational expansion of RDN to broader hypertensive cohorts.
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Liu et al. (2026) conducted a review in Hypertension (including resistant hypertension and mild-to-moderate hypertension). Renal denervation (RDN) vs. Sham procedure was evaluated on 24-hour ambulatory systolic blood pressure reduction (4.4-12.1 mm Hg reduction). Renal denervation reduces 24-hour ambulatory systolic blood pressure by 4.4–12.1 mm Hg with a favorable safety profile across randomized, sham-controlled trials.
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