Repositioning renal denervation in resistant hypertension: evidence-based insights, stratified decision-making, and implementation pathways.

Renal denervation (RDN) is a catheter-based interventional approach that targets renal sympathetic nerves to modulate sympathetic overactivity, a key pathophysiological driver of resistant hypertension and associated cardiovascular complications. In contrast to pharmacological approaches, the therapeutic effect of RDN does not rely on patient adherence. Originally indicated for severe resistant hypertension, RDN has since shown consistent antihypertensive efficacy across a broad range of hypertensive patients in recent sham-controlled studies. In this review, we discuss the pathophysiological foundation underlying RDN, consolidate the current clinical evidence supporting its therapeutic efficacy, describe the spectrum of available ablation technologies, and evaluate its expanding applications in conditions driven by sympathetic overactivity.