Recent update on renal denervation: where do we stand now?

Renal denervation (RDN) has re-emerged as a potential adjunctive therapy for hypertension following advances in device technology, trial design, and patient selection. Early enthusiasm for RDN declined after neutral findings from initial sham-controlled trials; however, subsequent randomized studies have consistently demonstrated modest but significant reductions in blood pressure (BP) across a range of clinical settings. Contemporary sham-controlled trials using radiofrequency-, ultrasound-, and alcohol-mediated approaches have shown that RDN lowers office and ambulatory BP both in the presence and absence of background antihypertensive therapy. Long-term follow-up data extending up to 3 years suggest that BP-lowering effects can be sustained, with no consistent signal of late-emerging safety concerns. Recent meta-analyses further support these findings, reporting modest but consistent reductions in systolic BP compared with sham procedures. Despite these advances, several limitations remain. The magnitude of BP reduction is modest, treatment response is heterogeneous, and definitive evidence for cardiovascular outcome benefit is lacking. Current international guidelines therefore position RDN as an adjunctive, rather than replacement, therapy for carefully selected patients with uncontrolled or resistant hypertension. This review summarizes the mechanistic rationale, key clinical trial evidence, long-term durability, safety considerations, and current guideline recommendations for RDN, and discusses future directions to better define its role in hypertension management.