Consensus and inconsistency between different consensus documents on renal denervation worldwide: the way forward

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Hypertension Management

Background:

• Uncontrolled hypertension and medication non-adherence remain significant global health challenges.
• Device therapy, specifically renal denervation (RDN), offers a potential solution for durable blood pressure reduction.
• Recent second-generation randomized trials confirm the safety and efficacy of RDN in hypertensive patients.

Purpose of the Study:

• To review and synthesize current consensus recommendations on renal denervation (RDN) for hypertension management.
• To identify areas of agreement and disagreement among international guidelines regarding RDN implementation.
• To highlight knowledge gaps and future research priorities for the broader adoption of RDN therapy.

Main Methods:

• Analysis of four key consensus documents on RDN from major hypertension and cardiology societies (THS/TSOC 2019, Asia Renal Denervation Consortium 2019, ESH 2021, SCAI/NKF 2021).
• Evaluation of recommendations concerning patient selection, pre-procedural assessment, and treatment strategies.
• Identification of consensus points and areas requiring further investigation.

Main Results:

• Consensus exists on recommending RDN as an alternative or complementary treatment for uncontrolled hypertension.
• Asian guidelines suggest RDN as a potential initial therapy for drug-naïve patients.
• Discrepancies remain regarding the routine use of ambulatory blood pressure monitoring and RDN for treatment-resistant secondary hypertension.

Conclusions:

• Multiple international guidelines support renal denervation (RDN) for managing resistant hypertension.
• Standardized clinical pathways and reimbursement strategies are recommended for RDN implementation.
• Urgent research is needed to address knowledge gaps, including predictors of response and effects on cardiovascular events, to facilitate wider RDN use.