The following are key points to remember from a European Clinical Consensus Statement on renal denervation in the management of hypertension in adults:

1. This statement represents a change from the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension in which device-based therapies, such as renal denervation, were not recommended unless in the context of clinical trials. Since that time, there have been trials published and new evidence, thereby warranting a new statement.
2. This statement recognizes that the highest-quality trials are multicenter, randomized, sham-controlled, and blinded and use ambulatory blood pressure (BP) as the primary outcome.
3. There have now been high-quality studies showing BP lowering over 24 hours using both radiofrequency and ultrasound renal denervation that have included subjects with mild-to-moderate, severe, and resistant hypertension.
4. Renal denervation did not result in any significant long-term increase in renal artery stenosis or worsening of renal function.
5. The BP-lowering effect of renal denervation was sustained for up to 3 years. Benefit is like a single medication, roughly 5-10 mm Hg, with some variation.
6. Many of the trials showed that nonadherence to BP medications was a major factor in poor BP control and care was taken to ensure that subjects were on appropriate medical therapy, although some subjects could not tolerate any medications or were on minimal medications.
7. Renal denervation may be of use in adults with uncontrolled or resistant hypertension (triple drug therapy, one of which is a diuretic) and may be an option for patients unable to tolerate long-term medications at the necessary doses or who cannot tolerate medications at all.
8. There may be a role for renal denervation in patients who simply do not wish to be on a medication. Patients must be fully informed about the risks and potential benefits of renal denervation when compared to drug therapy.
9. Renal denervation should be offered mainly to patients with high global cardiovascular risk, for whom intensive BP treatment may have a particularly pronounced benefit.
10. Centers offering renal denervation should include a multidisciplinary team of hypertension specialists and expert interventionalists who are trained specifically for renal denervation and whose outcomes are closely monitored.

Of note, renal denervation has NOT been approved as a therapy for hypertension in the United States but will likely be under review shortly—if not already.

Clinical Topics: Diabetes and Cardiometabolic Disease, Noninvasive Imaging, Prevention, Vascular Medicine, Echocardiography/Ultrasound, Hypertension

Keywords: Blood Pressure, Blood Pressure Monitoring, Ambulatory, Coronary Stenosis, Denervation, Diuretics, Hypertension, Hypertension, Renal, Primary Prevention, Renal Insufficiency, Ultrasonography, Interventional, Vascular Diseases

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