Renal denervation in contemporary clinical practice: patient profile and early outcomes

Background

Renal denervation (RDN) has re-emerged as a complementary therapeutic option for patients with difficult-to-control hypertension; however, real-world evidence regarding patient selection, safety, and blood pressure (BP) response remains limited.

Purpose

To assess patient characteristics, procedural safety, and mid-term changes in BP and antihypertensive treatment burden in a real-world cohort undergoing RDN.

Methods

Single-center retrospective study including consecutive patients undergoing RDN. Baseline characteristics, procedural data, and outcomes were collected. BP was assessed by ambulatory monitoring when available or home monitoring otherwise. Primary endpoints were procedural safety and systolic BP (SBP) change; secondary endpoints included diastolic BP (DBP), mean arterial pressure (MAP), antihypertensive burden, and renal function. Paired comparisons used the Wilcoxon signed-rank test.

Results

Thirty-one patients were included (61.3% male; mean age 52.9 ± 9.1 years). Hypertension was essential in 25 (80.6%) and secondary in 6 (19.4%), most frequently associated with obstructive sleep apnea. The cohort exhibited a high cardiometabolic burden, including obesity (38.7%), dyslipidemia (67.7%), type 2 diabetes (16.1%), chronic kidney disease (12.9%; median eGFR 92 [55–115] mL/min/1.73 m²), and obstructive sleep apnea (25.8%). Very high cardiovascular risk was present in 22.6%.

Resistant hypertension was the main indication for RDN (38.7%), followed by shared decision-making, drug intolerance, and uncontrolled hypertension with high cardiovascular risk. Hypertension-mediated organ damage was present in 32.3%, mainly cardiac and renal.

At baseline, patients were treated with a mean of 3.3 antihypertensive agents, with 71.0% receiving ≥3 drugs. All procedures were performed using the Simplicity Spyral system via femoral access with bilateral radiofrequency ablation. Median procedure time was 45 [39–49] minutes and hospital stay 1.5 [1–2] days. No procedure-related complications occurred.

Median follow-up was 11.8 months (IQR 5.9–17.8), with paired BP data available in 11 patients. Median SBP decreased by −11.0 mmHg (IQR −17.0 to −4.0), mean reduction −12.0 ± 14.1 mmHg (p = 0.014). MAP decreased significantly (median −8.7 mmHg; IQR −14.3 to −4.0; p = 0.041). DBP showed a non-significant reduction (median −8.0 mmHg; IQR −11.0 to 1.0; p = 0.266). Antihypertensive treatment burden decreased significantly (3.3 to 3.0 drugs per patient; p = 0.012). Renal function remained stable, with no significant change in serum creatinine (median −0.05 mg/dL; p = 0.19) or eGFR (median +2.0 mL/min/1.73 m²; p = 0.29).

Conclusions

In this real-world cohort, RDN was safe and associated with clinically meaningful SBP and MAP reduction, lower treatment burden, and preserved renal function. Variability in response highlights the need for careful patient selection and further research on predictors of benefit.