Renal Denervation for Resistant Hypertension

Patient Selection and Recommendations

The European Society of Cardiology recommends Renal Denervation (RDN) as an adjunctive treatment option for patients with resistant hypertension who remain uncontrolled on a combination of three antihypertensive medications, including a diuretic, and have undergone a thorough risk-benefit discussion and multidisciplinary assessment 1, 2
RDN may be considered for patients with increased cardiovascular risk and uncontrolled hypertension on less than three medications, provided they have undergone a shared risk-benefit discussion and multidisciplinary assessment 3
The European Society of Cardiology does not recommend RDN as a first-line treatment for hypertension due to limited evidence on its safety and cardiovascular benefits 2, 3

RDN is not recommended for patients with moderate to severe renal impairment (eGFR <40 mL/min/1.73 m²) or secondary hypertension 2

Suitable patients for RDN should have true resistant hypertension, defined as uncontrolled blood pressure on three antihypertensive medications, including a diuretic 1, 2
Before considering RDN, true treatment resistance should be confirmed, treatment adherence should be accurately assessed, and pseudo-resistance should be excluded 4
Factors contributing to treatment resistance, including secondary hypertension causes, should be identified 4
RDN should be performed in medium to high-volume centers to ensure procedural quality and safety 2, 3
Multidisciplinary assessment and shared risk-benefit discussion are required 2, 3