Renal Denervation for Uncontrolled Hypertension: A Measurement-First, Program-Based Approach.

Area of Science:

• Cardiology
• Nephrology
• Hypertension Management

Background:

• Renal denervation (RDN) is a re-emerging adjunctive therapy for uncontrolled or resistant hypertension.
• Contemporary trials demonstrate a modest, reproducible reduction in out-of-office blood pressure post-RDN.
• Pseudoresistance, due to measurement errors or nonadherence, often complicates treatment assessment.

Purpose of the Study:

• To review current evidence on RDN for uncontrolled and resistant hypertension.
• To propose a practical framework for patient selection, care integration, and response assessment.
• To emphasize a measurement-first approach in managing resistant hypertension.

Main Methods:

• Narrative, implementation-focused review of RDN evidence.
• Systematic literature search of major databases (PubMed, Embase, Cochrane, Web of Science) through January 2026.
• Prioritization of sham-controlled trials, meta-analyses, guidelines, and studies on blood pressure monitoring and adherence.

Main Results:

• Sham-controlled trials support RDN as an adjunctive therapy with modest blood pressure lowering (4-6 mmHg systolic ambulatory BP reduction).
• Effective RDN requires confirmed sustained hypertension, exclusion of pseudoresistance, optimized medical therapy, and adherence assessment.
• Identified patient phenotypes likely to benefit and proposed a framework for post-procedural response assessment.

Conclusions:

• RDN is an adjunct, not a replacement, for antihypertensive therapy, suitable for carefully selected patients.
• A measurement-first care pathway is proposed to integrate RDN evidence into routine practice.
• The proposed model is a pragmatic clinical tool, not a formally validated algorithm or consensus recommendation.