Renal denervation for resistant hypertension: yes.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Nephrology

Background:

• Sympathetic overactivity is implicated in resistant hypertension.
• Catheter-based renal denervation (RDN) emerged as a potential treatment for refractory hypertension.
• The Symplicity HTN-3 trial presented limitations, yielding inconclusive results on RDN's efficacy.

Purpose of the Study:

• To review current data on renal denervation (RDN) for resistant hypertension.
• To discuss insights and future opportunities in RDN research and patient selection.
• To address the redefinition of denervation concepts and treatment strategies.

Main Methods:

• Review of existing clinical trial data, focusing on randomized, sham-controlled studies.
• Analysis of the Symplicity HTN-3 trial and its limitations.
• Examination of ongoing and future sham-controlled trials for RDN.

Main Results:

• The Symplicity HTN-3 trial did not confirm prior blood pressure-lowering effects of RDN.
• Study limitations in Symplicity HTN-3 prevent definitive conclusions on RDN efficacy.
• Research is ongoing to redefine RDN strategies and identify patient subgroups benefiting from the procedure.

Conclusions:

• Further research and redefined strategies are necessary to establish the role of RDN in resistant hypertension.
• New generations of trials aim to identify patient selection criteria for optimal RDN outcomes.
• The potential of RDN requires continued investigation to overcome previous trial limitations.