The following are key points to remember from this state-of-the-art review on renal denervation for treating hypertension:

1. Available data suggest that over 1 billion people worldwide have hypertension (HTN) and that over 9 million annual deaths can be attributed to complications of HTN such as myocardial infarction, stroke, and renal failure.
2. As some patients cannot or will not take medications on a daily basis, device-based blood pressure (BP) lowering therapy such as renal denervation (RDN) could be a valuable additive or alternative treatment option. 1.
3. Transcatheter renal denervation (RDN) is an emerging clinical procedure for treating hypertension.
4. The first randomized sham-controlled trial, SYMPLICITY HTN-3, did not show significantly lower office or 24-hour ambulatory systolic BP compared with sham treatment.
5. Subsequent preclinical and clinical studies in both animals and humans demonstrated the potential importance of more distal and branch renal artery radiofrequency ablation, and a second-generation multielectrode system became available. 2.
6. Two recent randomized sham-controlled trials in patients not taking antihypertensive drugs (SPYRAL HTN-OFF MED) or continuing to take drugs (SPYRAL HTN-ON MED) performed RDN with the second-generation radiofrequency ablation system using an ablation protocol that included treatment of the distal renal artery as well as the branch renal arteries. These studies showed that RDN significantly reduced office and 24-hour ambulatory BP compared with sham treatment.
7. Another randomized sham-controlled trial in patients not receiving medication showed that RDN with catheter-based ultrasound (RADIANCE-HTN SOLO) applied in just the main renal arteries significantly lowered daytime ambulatory and office BP compared with sham treatment.
8. These trials have renewed clinical and scientific interest in defining the appropriate role of RDN in hypertension treatment.
9. Although these studies have shown that RDN produces a consistent decrease in BP, a major limitation of these studies is that RDN was performed in a small number of selected patients and follow-up was very short at ≤6 months.
10. Randomized controlled trials in larger, less selected populations with longer follow-up are needed to validate BP benefits, assess safety, and further define the role of this procedure in managing hypertension.

Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Cardiology Interventions, Denervation, Hypertension, Myocardial Infarction, Primary Prevention, Renal Insufficiency, Stroke, Vascular Diseases, Ultrasonography

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