Renal denervation for hypertension management: convergence and divergence across international guidelines

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Hypertension Management

Background:

• Renal denervation (RDN) is an emerging interventional therapy for managing hypertension.
• Three prominent international guidelines (ESC 2024, ESH 2023, ACC/AHA 2025) have recently published recommendations on RDN.

Purpose of the Study:

• To conduct a comparative analysis of the latest international guidelines on renal denervation.
• To synthesize and compare the indications and recommendations for RDN from the ESC, ESH, and ACC/AHA guidelines.

Main Methods:

• A structured comparative analysis of guideline recommendations was performed.
• Key domains analyzed included patient selection, recommendation strength, evidence levels, procedural aspects, and clinical positioning.
• Independent review by two authors with consensus resolution for discrepancies ensured rigorous analysis.

Main Results:

• All guidelines identify four primary indications for RDN: uncontrolled hypertension, resistant hypertension, drug intolerance, and patient preference.
• Divergences exist in the strength of recommendations and specific patient selection criteria, though apparent differences in recommendation classes are attributed to grading framework variations.
• Expected blood pressure reduction is modest (4-6 mmHg ambulatory systolic), comparable to one antihypertensive medication, translating to an estimated 10% reduction in major cardiovascular events.

Conclusions:

• Renal denervation is positioned as a complementary therapeutic option for hypertension management.
• Multidisciplinary evaluation and shared decision-making are crucial for optimal RDN implementation.
• Individual patient responses to RDN for blood pressure control and cardiovascular event reduction can vary significantly.