Renal denervation for managing hypertension: Key elements in selecting and referring patients

Renal denervation (RDN) is an innovative procedure with regulatory approval for treating patients whose blood pressure remains uncontrolled despite lifestyle changes and the prescription of antihypertensive medications. It is important to consider how to create accessible patient referral pathways for this complementary therapy in the context of differing healthcare systems and the availability of appropriate resources. Today, most hypertensive patients are managed by primary care practitioners in the community. This paper considers various program models that integrate RDN into clinical practice, from decentralized systems where community physicians refer patients to an RDN facility, to centralized hypertension or academic centers that provide comprehensive care. Providing community practices with checklists that guide patient selection for possible referral for RDN is an important start to the process. Key to the success of an RDN program at an interventional facility is the careful selection of patients. Ideally, this is managed by a team that includes interventional physicians skilled in the RDN procedure, clinicians knowledgeable about hypertension management who can confirm the suitability of patients referred for the procedure, and supporting nursing staff to guide patients through the process. By adopting the practices outlined in this paper, the availability of RDN can be appropriately applied to improving hypertension control in patients at need, in turn reducing their risk of adverse cardiovascular outcomes.