Renal denervation in 2025: long-term evidence supporting sympathetic modulation as a durable strategy for...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Hypertension Management

Background:

• Renal denervation (RDN) is an emerging device-based therapy for resistant hypertension.
• Recent major cardiovascular conferences presented 3-year follow-up data on RDN's efficacy and safety.
• Uncontrolled hypertension remains a significant global health challenge requiring innovative treatment strategies.

Purpose of the Study:

• To synthesize 3-year follow-up data on renal denervation (RDN) for uncontrolled hypertension.
• To evaluate the sustained efficacy and safety of RDN based on randomized trials and real-world registry data.
• To assess the impact of RDN on blood pressure control and acute hypertensive events.

Main Methods:

• Synthesis of data from SPYRAL HTN-ON MED, GSR-DEFINE registry, SPYRAL AFFIRM, and pooled analyses.
• Comparison of randomized sham-controlled trials with observational registry data.
• Analysis of office systolic blood pressure (SBP) reduction and acute hypertensive events at 3-year follow-up.

Main Results:

• Sustained office SBP reduction of -18.5 mmHg with RDN vs. -11.7 mmHg with sham at 3 years (SPYRAL HTN-ON MED).
• Global Symplicity Registry DEFINE showed -20.5 mmHg office SBP reduction at 3 years, with effects increasing over time.
• Pooled analysis indicated a 43% reduction in acute hypertensive events; no renal artery stenosis or reintervention needed.

Conclusions:

• RDN demonstrates durable and safe adjunctive therapy for selected patients with uncontrolled hypertension.
• Benefits of RDN extend to high-risk populations, including those with diabetes, CKD, and prior stroke.
• Long-term cardiovascular outcome data are still pending but initial results are promising.