The correct answer is: E. Measure plasma aldosterone and renin levels.

While FDA approval allows for a broad range of patients to be eligible for renal denervation, a comprehensive workup should be performed prior to referral for renal denervation. This includes screening for secondary causes of hypertension, as well as confirming adherence to antihypertensive therapies and controlling other contributing factors such as obstructive sleep apnea (OSA). In this case, the patient has resistant hypertension, defined as inadequately controlled blood pressure on three different antihypertensive therapies (including a diuretic) or controlled on four different antihypertensive therapies.

The first stage of the workup should focus on ruling out secondary causes of hypertension such as primary hyperaldosteronism by obtaining plasma aldosterone and renin levels. White coat hypertension can be evaluated by performing with 24-hour ambulatory blood pressure measurements. Non-invasive imaging such as CT angiography or duplex ultrasonography can be used to rule out renal artery stenosis. Targeted assessment for other secondary causes such as pheochromocytoma or hypercortisolism should be based on clinical presentation.

If all of these factors have been ruled out, renal denervation as a therapeutic intervention can be considered.