The return of renal denervation in the treatment of arterial hypertension: new evidence and clinical indications

Improved and durable control of hypertension is a global priority for healthcare providers and policymakers. Despite all the efforts, hypertension is still misdiagnosed in half of hypertensive patients and poor drug adherence, reaching half of drug-treated patients, represents the major cause of uncontrolled hypertension. Initial studies on renal denervation (RDN) for the treatment of uncontrolled resistant hypertension produced conflicting results. A new generation of randomized clinical trials has shown promising results with new-generation devices in various hypertensive populations. From uncontrolled-resistant hypertension, the target population for RDN has moved to difficult-to-treat or resistant hypertensive patients. The selection process should take into account not only blood pressure values and the global cardiovascular risk profile, but also drug adherence and tolerability and patient preferences. The following is a state-of-the-art review of current studies and an analysis of the characteristics of hypertensive patients that could benefit from RDN.