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

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Nephrology

Background:

• Resistant hypertension poses a significant clinical challenge, with limited effective treatment options.
• Renal denervation (RDN) offers a promising therapeutic avenue, but its efficacy is hampered by significant variability and non-response rates.
• The heterogeneity in RDN outcomes is attributed to inter-individual differences in sympathetic nervous system activation and procedural limitations causing incomplete denervation.

Purpose of the Study:

• To review recent advancements in precision patient selection for RDN.
• To explore procedural refinements aimed at improving the consistency and efficacy of RDN.
• To propose a framework for optimizing RDN therapy through integrated patient stratification and ablation techniques.

Main Methods:

• Comprehensive literature review of recent studies on RDN patient selection and procedural techniques.
• Synthesis of data on factors influencing sympathetic nervous system activation in hypertension.
• Analysis of current limitations and innovations in RDN procedures.

Main Results:

• Advances in patient selection strategies are emerging to identify individuals most likely to benefit from RDN.
• Procedural refinements are being developed to enhance the completeness and precision of sympathetic denervation.
• A conceptual framework integrating patient stratification and procedural optimization is proposed to improve therapeutic consistency.

Conclusions:

• Addressing inter-individual variability and procedural limitations is crucial for enhancing RDN efficacy.
• Precision medicine approaches, combining targeted patient selection with refined ablation techniques, are key to unlocking RDN's full potential.
• This work provides insights to support the reliable clinical translation of RDN for resistant hypertension.