Dr. Sultan Alotaibi, MD MSc FESC FSCAI

1. What is specific about hypertension in the Gulf region?

Hypertension in the Gulf is strongly linked to the regional cardiometabolic profile: high rates of obesity, diabetes, dyslipidemia, sedentary lifestyle, and early cardiovascular disease. We also see hypertension at relatively younger ages, often combined with multiple risk factors rather than as an isolated condition. Another important point is adherence. Many patients are asymptomatic, busy, and not convinced they need lifelong therapy for a disease they cannot “feel.”

2. Are there other suitable patient populations beyond those studied in RDN trials?

Yes, but carefully selected. Beyond classic resistant hypertension, I see potential in patients with uncontrolled hypertension and high cardiovascular risk, especially those with diabetes, established coronary disease, chronic kidney disease with preserved eligibility, heart failure, or significant medication intolerance. Patients with poor adherence despite repeated counseling may also be relevant, provided secondary causes are excluded and ambulatory BP confirms uncontrolled hypertension.

3. What is the attitude of newly diagnosed patients toward lifelong drug therapy in the Gulf?

Many patients are reluctant at the beginning. The idea of taking daily medication for life is often perceived as a sign of illness or dependency. Some prefer lifestyle changes first, some stop treatment once BP improves, and some use medications intermittently. This makes education essential. We need to explain that hypertension is not only a number, but a long-term risk for stroke, kidney disease, heart failure, and myocardial infarction.

4. Could there be other approaches beyond traditional referral pathways?

Definitely. We need to move beyond waiting for referrals. Screening could be integrated into diabetes clinics, obesity clinics, cardiac rehabilitation, primary care, pharmacies, occupational health programs, and community campaigns. Digital health, home BP monitoring, and structured nurse-led hypertension pathways could also help identify uncontrolled patients earlier. In the Gulf, hospitals and large healthcare systems can build direct pathways between primary care, cardiology, nephrology, and interventional hypertension programs.

5. What is your view on ESC 2024 guidance allowing RDN in uncontrolled hypertension on fewer than three drugs with high CV risk?

I think this is very relevant for our region because many Gulf patients have high cardiovascular risk even before they reach the classical “three-drug resistant hypertension” definition. Diabetes, coronary artery disease, dyslipidemia, chronic kidney disease, and obesity are very common. So, a broader approach makes clinical sense, especially when BP remains uncontrolled despite appropriate treatment and the patient prefers a device-based option after shared decision-making.

6. How relevant will the publication of the Gulf Intervention Society (GIS) consensus on RDN be?

Very relevant. International guidelines are important, but regional guidance gives clinicians and hospitals a practical framework that reflects Gulf healthcare systems, referral patterns, patient profiles, and reimbursement realities. The GIS document can help standardize patient selection, procedural requirements, follow-up, and multidisciplinary collaboration.

7. What are the relevant messages of the consensus paper?

For me, the key messages are: RDN should be considered an adjunct, not a replacement for lifestyle and medical therapy; patient selection is critical; uncontrolled hypertension should be confirmed objectively, preferably with ambulatory BP monitoring; secondary causes should be excluded; and the procedure should be performed in experienced centers with structured follow-up. The consensus also reinforces that RDN is no longer an experimental curiosity, but a therapy that requires proper governance and responsible implementation.

8. How is the Perception of RDN among stakeholders?

I would assess it this way:

• Interventional cardiologists:Generally interested, especially because the procedure is catheter-based and technically familiar. The challenge is avoiding overenthusiasm and ensuring proper selection.
• Cardiologists:Often cautiously positive, particularly for high-risk uncontrolled patients. They need confidence in evidence, durability, safety, and patient pathways.
• Nephrologists:Their involvement is essential. Some may be cautious because of renal artery safety, CKD considerations, and secondary hypertension work-up. Collaboration is key.
• GPs and internists:Awareness is probably limited. They need simple referral criteria and education on which patients may benefit.
• Patients:Many like the idea of reducing BP burden without adding more drugs, but they must understand that RDN is not a cure and does not automatically stop medications.
• Public:Awareness is low. Public messaging should be careful, avoiding the impression that this is a “one-time fix” for hypertension.

These perceptions should be addressed through education, joint society statements, multidisciplinary clinics, case-based workshops, patient materials in Arabic and English, and clear referral algorithms.

9. How do you discuss RDN with eligible patients?

I explain that RDN is an additional treatment option for patients whose BP remains uncontrolled despite good care, or who are struggling with medication burden or tolerance. I stress that it is not a magic cure and not a replacement for healthy lifestyle. I discuss expected BP reduction, procedural safety, the need for continued follow-up, and the possibility that medications may still be needed. My advice to colleagues is to be balanced: do not oversell it, do not dismiss it, and select patients carefully.

10. What do you think of ultrasound renal denervation?

Ultrasound RDN is attractive because it offers circumferential energy delivery with a standardized approach. From a procedural standpoint, consistency and simplicity matter, especially when therapy moves from trials into broader clinical practice. Patients undergoing ultrasound RDN can typically be managed with light (conscious) sedation rather than general anesthesia. The key remains proper anatomy, operator training, and structured follow-up. Technology matters, but patient selection matters more.

11. How do you envision the future of the RDN in the region and around the world?

RDN is part of the hypertension treatment pathway, particularly for resistant hypertension and uncontrolled hypertension in high-risk patients. In the Gulf, the need is substantial because of the burden of diabetes, obesity, and cardiovascular disease. Worldwide, the future will depend on long-term durability data, cost-effectiveness, reimbursement, and integration into multidisciplinary care. RDN is not replacing medications but provides an important additional alternative for selected patients.