Renal denervation: from innovation to routine care

This 2026 narrative review, by a group of authors in Australia, provides a timely and authoritative overview of how renal denervation (RDN) has evolved from a promising concept to an evidence-based, guideline‑endorsed therapy for hypertension, and what this means for real‑world implementation.

The authors trace the journey of RDN from early enthusiasm, through the recalibration that followed some neutral trial results, to today’s strong evidence base. A series of well‑designed, sham‑controlled randomised clinical trials using second‑generation technologies have now consistently demonstrated that RDN safely delivers clinically meaningful reductions in both office and ambulatory blood pressure. These effects are shown in patients with uncontrolled or resistant hypertension, whether on antihypertensive medications or temporarily off them.

Beyond short‑term efficacy, long‑term observational data show that blood pressure lowering after RDN appears to be durable past 10 years, often accompanied by a reduced medication burden. This durability reinforces the role of RDN as a complementary option alongside pharmacological therapy, particularly for patients who struggle to achieve control despite multiple drugs.

Reflecting this growing body of evidence, major international hypertension guidelines now recommend RDN as an adjunctive treatment for selected patients with uncontrolled or resistant hypertension, when other strategies have failed or are poorly tolerated. The review highlights shared decision‑making as central to patient selection, taking into account blood pressure phenotype, comorbidities, patient preferences and expectations.

While RDN is approved in the United States and several other regions, the authors note that limited reimbursement in much of Europe and the Asia‑Pacific region remains a key barrier to widespread adoption, despite favourable cost‑effectiveness analyses. Practical recommendations are provided on diagnostic work‑up, referral pathways and team‑based care models to support safe and effective implementation once access barriers are addressed.

Finally, the review looks beyond hypertension. Ongoing research is exploring the likely expansion of RDN’s potential into other conditions characterised by heightened sympathetic activity, including chronic kidney disease, atrial fibrillation and heart failure.

A central message from the review is that RDN should no longer be thought of as an experimental therapy. It is an increasingly integrated, evidence‑based option that expands the therapeutic toolkit for long-term blood pressure management.

“Recent international guidelines uniformly recommend a BP target of <130/80mmHg for patient with hypertension and RDN is now considered an integral part of our therapeutic armamentarium to get our patients there…the favorable safety profile of RDN as a one-off procedure paired with clinically meaningful BP lowering that is durable out to 10 years will facilitate the much needed implementation into real-world clinical care pathways.”

Professor Markus Schlaich, Dobney Chair in Clinical Research

Reference: Sesa-Ashton G, et al. Heart Epub. doi:10.1136/heartjnl2025-326186