A unique strategy for treating individuals with drug-resistant hypertension has emerged: renal denervation. Utilizing multielectrode RF ablation systems, only a small amount of data have been published thus far.

The largest preventable cause of heart attack, stroke, and mortality in the United States and around the world is hypertension. In the United States, approximately 50% of adults suffer from hypertension, making it a widespread condition. Renal denervation with a catheter (RDN) is an endovascular, device-based method of treating hypertension that has shown promise in preliminary clinical trials. The renal arteries' afferent and efferent sympathetic innervation is cut off by RDN. Vascular resistance, renin release, and salt absorption are all decreased as a result. Despite its negative effects on health, the persistence of uncontrolled hypertension offers a chance to create device-based treatments that could help a wide range of patient populations. Based on early observational studies and an unblinded randomised trial that suggested clinically significant BP reductions in patients with severe treatment-resistant hypertension catheter-based renal denervation (RDN) was anticipated to be a game-changing treatment with implications for global public health.

Long-standing research has shown the impact of renal denervation on hypertension and other disease states, and it is well known that the sympathetic nervous system plays a role in the development and maintenance of hypertension. It is widely known that kidneys function as both senders and receivers of sympathetic signals that go in both directions along afferent or efferent sympathetic fibres. Transvascular procedures can cause heat damage to the afferent and efferent sympathetic fibres that pass through the adventitia of the renal artery. 

An increasing issue with unmet medical needs is resistant hypertension, which is defined as uncontrolled hypertension despite the use of at least three antihypertensive drugs, one of which is a diuretic. Resistant hypertension is the best option for interventional treatments due to its resistance to medication therapy, sympathetic nervous system activation, the importance of renal nerves in the development of hypertension, and the simplicity with which catheter-based techniques can access sympathetic fibres.

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Archives of General Internal Medicine