Renal Denervation: A New Era in the Management of Resistant Hypertension

Hypertension is one of the leading causes of mortality related to cardiovascular disease. Since the advent of modern medicine, a multitude of efforts have been made to achieve better BP control. However, despite a wide range of monitoring protocols and medication therapies, only 23% of patients with hypertension achieve BP control. Renal denervation (RDN) has emerged as an adjunctive therapy to medications and lifestyle modification for BP control. Two methods of RDN were approved by the US Department of Food and Drug Administration in 2023: Radiofrequency ablation and an ultrasound-based method. Radiofrequency ablation uses heat-generating electrodes placed on the renal artery using a catheter and delivers heat through alternating current. Ultrasound-based technique uses ultrasonic heating to create a ring of ablative energy that interrupts renal nerve signaling. Over the past two decades, well-conducted randomized sham control trials and registry analysis have proven RDN to be an effective and safe treatment option for resistant hypertension with promising results. RDN also becomes appealing in patients with CKD who have an underlying sympathetic overactivity. This article aims to provide a comprehensive review of RDN, including current evidence and its implications in routine clinician practice.