Overcoming variable response in renal denervation: Key strategies for reliable clinical implementation

While renal denervation (RDN) represents a promising therapy for resistant hypertension, substantial heterogeneity in blood pressure-lowering efficacy and a significant treatment non-response rate (reaching up to one-third of cases) impede its broader clinical adoption. This variability likely arises from two primary sources: interindividual differences in sympathetic nervous system activation among hypertensive patients (the pathological substrate for ablation) and procedural limitations ("black-box procedure") leading to incomplete sympathetic denervation. Our comprehensive review synthesizes recent advances in precision patient selection and procedural refinement for RDN. Furthermore, we propose a conceptual framework aimed at enhancing therapeutic consistency through the integrated optimization of patient stratification and ablation techniques. We believe this work provides insights to support the reliable clinical translation of RDN. Key strategies to improve treatment response to RDN. Notes: RDN, renal denervation; HR, heart rate; BRS, baroreflex sensitivity; PWV, pulse wave velocity; AASI, arterial stiffness index; TAC, total arterial compliance; RNS, renal nerve stimulation.