Advances in the application of renal denervation for resistant hypertension_West China Medical Journal

Authors：

ZHANG Chunle , LIU Caihong ,  FU Ping

Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

FU Ping, Email: fupinghx@scu.edu.cn

Keywords：

Renal denervation; resistant hypertension; sympathetic nerve

DOI：

10.7507/1002-0179.202606123

Video：

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Resistant hypertension poses a challenge in hypertension management, as some patients still experience difficulty in achieving stable blood pressure control despite undergoing standard treatment. Renal denervation (RDN) provides a device-based therapeutic alternative to pharmacotherapy by modulating renal sympathetic nerve activity. In recent years, with the advancement of ablation techniques such as radiofrequency and ultrasound, coupled with the accumulation of evidence from sham surgery control studies and long-term follow-up studies, the clinical value and application boundaries of RDN have garnered renewed attention. This article aims to summarize the progress of RDN in the treatment of refractory hypertension, highlighting its clinical research evidence, target population, renal safety, guideline positioning, and future research directions, with the hope of providing a reference for its standardized clinical application.

Citation： ZHANG Chunle, LIU Caihong, FU Ping. Advances in the application of renal denervation for resistant hypertension. West China Medical Journal, 2026, 41(7): 1057-1061. doi: 10.7507/1002-0179.202606123 Copy

1.	Mills KT, Stefanescu A, He J. The global epidemiology of hypertension[J]. Nat Rev Nephrol, 2020, 16(4): 223-237.
2.	Tanner RM, Calhoun DA, Bell EK, et al. Prevalence of apparent treatment-resistant hypertension among individuals with CKD[J]. Clin J Am Soc Nephrol, 2013, 8(9): 1583-1590.
3.	Carey RM, Calhoun DA, Bakris GL, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association[J]. Hypertension, 2018, 72(5): e53-e90.
4.	中國高血壓防治指南修訂委員會, 高血壓聯盟(中國), 中國醫療保健國際交流促進會高血壓分會, 等. 中國高血壓防治指南(2024 年修訂版)[J]. 中華高血壓雜志, 2024, 32(7): 603-700.
5.	Bansal S. Revisiting resistant hypertension in kidney disease[J]. Curr Opin Nephrol Hypertens, 2024, 33(5): 465-473.
6.	Tsioufis C, Kordalis A, Flessas D, et al. Pathophysiology of resistant hypertension: the role of sympathetic nervous system[J]. Int J Hypertens, 2011, 2011: 642416.
7.	Sim JJ, Bhandari SK, Shi J, et al. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension[J]. Kidney Int, 2015, 88(3): 622-632.
8.	Evans LC, Dayton A, Osborn JW. Renal nerves in physiology, pathophysiology and interoception[J]. Nat Rev Nephrol, 2025, 21(1): 57-69.
9.	Wilson AL, Gandhi J, Suh Y, et al. Renal innervation in resistant hypertension: a review of pathophysiology and renal denervation as potential treatment[J]. Curr Hypertens Rev, 2020, 16(2): 115-127.
10.	Katsurada K, Shinohara K, Aoki J, et al. Renal denervation: basic and clinical evidence[J]. Hypertens Res, 2022, 45(2): 198-209.
11.	Sharp ASP, Fisher NDL. Renal denervation to treat hypertension: a clinical state-of-the-art review[J]. Am J Hypertens, 2026, 39(3): 355-364.
12.	Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1,266 cases[J]. J Am Med Assoc, 1953, 152(16): 1501-1504.
13.	Krum H, Schlaich M, Whitbourn R, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study[J]. Lancet, 2009, 373(9671): 1275-1281.
14.	Mountfort K, Mahfoud F, Schmieder R, et al. Catheter-based renal sympathetic denervation - long-term Symplicity? renal denervation clinical evidence, new data and future perspectives[J]. Interv Cardiol, 2013, 8(2): 118-123.
15.	B?hm M, Townsend RR, Kario K, et al. Rationale and design of two randomized sham-controlled trials of catheter-based renal denervation in subjects with uncontrolled hypertension in the absence (SPYRAL HTN-OFF MED pivotal) and presence (SPYRAL HTN-ON MED expansion) of antihypertensive medications: a novel approach using Bayesian design[J]. Clin Res Cardiol, 2020, 109(3): 289-302.
16.	Pathak A, Rudolph UM, Saxena M, et al. Alcohol-mediated renal denervation in patients with hypertension in the absence of antihypertensive medications[J]. EuroIntervention, 2023, 19(7): 602-611.
17.	Esler MD, Krum H, Schlaich M, et al. Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2 randomized, controlled trial[J]. Circulation, 2012, 126(25): 2976-2982.
18.	Krum H, Schlaich MP, Sobotka PA, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study[J]. Lancet, 2014, 383(9917): 622-629.
19.	Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant hypertension[J]. N Engl J Med, 2014, 370(15): 1393-1401.
20.	B?hm M, Kario K, Kandzari DE, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial[J]. Lancet, 2020, 395(10234): 1444-1451.
21.	Kandzari DE, B?hm M, Mahfoud F, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial[J]. Lancet, 2018, 391(10137): 2346-2355.
22.	Mahfoud F, Kandzari DE, Kario K, et al. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial[J]. Lancet, 2022, 399(10333): 1401-1410.
23.	Kandzari DE, Mahfoud F, Townsend RR, et al. Long-term safety and efficacy of renal denervation: 24-month results from the SPYRAL HTN-ON MED trial[J]. Circ Cardiovasc Interv, 2025, 18(7): e015194.
24.	Azizi M, Sanghvi K, Saxena M, et al. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial[J]. Lancet, 2021, 397(10293): 2476-2486.
25.	Azizi M, Schmieder RE, Mahfoud F, et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial[J]. Lancet, 2018, 391(10137): 2335-2345.
26.	Azizi M, Saxena M, Wang Y, et al. Endovascular ultrasound renal denervation to treat hypertension: the RADIANCE II randomized clinical trial[J]. JAMA, 2023, 329(8): 651-661.
27.	Mahfoud F, B?hm M, Schmieder R, et al. Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the global Symplicity registry[J]. Eur Heart J, 2019, 40(42): 3474-3482.
28.	Bhatt DL, Vaduganathan M, Kandzari DE, et al. Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised Symplicity HTN-3 trial[J]. Lancet, 2022, 400(10361): 1405-1416.
29.	Schlaich MP, Mahfoud F, B?hm M, et al. Renal denervation in patients with moderate to severe chronic kidney disease[J]. Hypertension, 2025, 82(12): 2252-2261.
30.	Reyes KRL, Rader F. Long-term safety and antihypertensive effects of renal denervation: current insights[J]. Integr Blood Press Control, 2023, 16: 59-70.
31.	Persu A, Sapoval M, Azizi M, et al. Renal artery stenosis following renal denervation: a matter of concern[J]. J Hypertens, 2014, 32(10): 2101-2105.
32.	Patel HC, Hayward C, Vassiliou V, et al. Renal denervation for the management of resistant hypertension[J]. Integr Blood Press Control, 2015, 8: 57-69.
33.	Zweiker D, Lambert T, Steinwender C, et al. Effects of renal denervation documented in the Austrian national multicentre renal denervation registry[J]. PLoS One, 2016, 11(8): e0161250.
34.	Moriarty JM, Tung R, Bradfield JS, et al. Renal denervation: a novel therapy at the crossroads of imaging, intervention, and innovation[J]. J Lab Autom, 2016, 21(2): 312-316.
35.	Mohammad AA, Nawar K, Binks O, et al. Effects of renal denervation on kidney function in patients with chronic kidney disease: a systematic review and meta-analysis[J]. J Hum Hypertens, 2024, 38(1): 29-44.
36.	Ott C, Mahfoud F, Schmid A, et al. Improvement of albuminuria after renal denervation[J]. Int J Cardiol, 2014, 173(2): 311-315.
37.	Yamazaki D, Konishi Y, Kitada K. Effects of renal denervation on the kidney: albuminuria, proteinuria, and renal function[J]. Hypertens Res, 2024, 47(10): 2659-2664.
38.	李月平, 盧成志, 蔣雄京, 等. 經皮去腎神經術治療高血壓中國專家科學聲明[J]. 中國介入心臟病學雜志, 2023, 31(12): 881-893.
39.	Barbato E, Azizi M, Schmieder RE, et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC council on hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)[J]. Eur Heart J, 2023, 44(15): 1313-1330.
40.	Mancia G, Kreutz R, Brunstr?m M, et al. 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)[J]. J Hypertens, 2023, 41(12): 1874-2071.
41.	Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines[J]. J Am Coll Cardiol, 2025, 86(18): 1567-1678.
42.	McCarthy CP, Bruno RM, McEvoy JW, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: what is new in pharmacotherapy?[J]. Eur Heart J Cardiovasc Pharmacother, 2025, 11(1): 7-9.
43.	國家放射與治療臨床醫學研究中心, 蘇州工業園區東方華夏心血管健康研究院高血壓介入治療工作委員會, 《經皮去腎神經術治療高血壓臨床路徑中國專家共識(2025 版)》專家組, 等. 經皮去腎神經術治療高血壓臨床路徑中國專家共識(2025 版)[J]. 中國介入心臟病學雜志, 2025, 33(9): 481-490.

1. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension[J]. Nat Rev Nephrol, 2020, 16(4): 223-237.
2. Tanner RM, Calhoun DA, Bell EK, et al. Prevalence of apparent treatment-resistant hypertension among individuals with CKD[J]. Clin J Am Soc Nephrol, 2013, 8(9): 1583-1590.
3. Carey RM, Calhoun DA, Bakris GL, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association[J]. Hypertension, 2018, 72(5): e53-e90.
4. 中國高血壓防治指南修訂委員會, 高血壓聯盟(中國), 中國醫療保健國際交流促進會高血壓分會, 等. 中國高血壓防治指南(2024 年修訂版)[J]. 中華高血壓雜志, 2024, 32(7): 603-700.
5. Bansal S. Revisiting resistant hypertension in kidney disease[J]. Curr Opin Nephrol Hypertens, 2024, 33(5): 465-473.
6. Tsioufis C, Kordalis A, Flessas D, et al. Pathophysiology of resistant hypertension: the role of sympathetic nervous system[J]. Int J Hypertens, 2011, 2011: 642416.
7. Sim JJ, Bhandari SK, Shi J, et al. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension[J]. Kidney Int, 2015, 88(3): 622-632.
8. Evans LC, Dayton A, Osborn JW. Renal nerves in physiology, pathophysiology and interoception[J]. Nat Rev Nephrol, 2025, 21(1): 57-69.
9. Wilson AL, Gandhi J, Suh Y, et al. Renal innervation in resistant hypertension: a review of pathophysiology and renal denervation as potential treatment[J]. Curr Hypertens Rev, 2020, 16(2): 115-127.
10. Katsurada K, Shinohara K, Aoki J, et al. Renal denervation: basic and clinical evidence[J]. Hypertens Res, 2022, 45(2): 198-209.
11. Sharp ASP, Fisher NDL. Renal denervation to treat hypertension: a clinical state-of-the-art review[J]. Am J Hypertens, 2026, 39(3): 355-364.
12. Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1,266 cases[J]. J Am Med Assoc, 1953, 152(16): 1501-1504.
13. Krum H, Schlaich M, Whitbourn R, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study[J]. Lancet, 2009, 373(9671): 1275-1281.
14. Mountfort K, Mahfoud F, Schmieder R, et al. Catheter-based renal sympathetic denervation - long-term Symplicity? renal denervation clinical evidence, new data and future perspectives[J]. Interv Cardiol, 2013, 8(2): 118-123.
15. B?hm M, Townsend RR, Kario K, et al. Rationale and design of two randomized sham-controlled trials of catheter-based renal denervation in subjects with uncontrolled hypertension in the absence (SPYRAL HTN-OFF MED pivotal) and presence (SPYRAL HTN-ON MED expansion) of antihypertensive medications: a novel approach using Bayesian design[J]. Clin Res Cardiol, 2020, 109(3): 289-302.
16. Pathak A, Rudolph UM, Saxena M, et al. Alcohol-mediated renal denervation in patients with hypertension in the absence of antihypertensive medications[J]. EuroIntervention, 2023, 19(7): 602-611.
17. Esler MD, Krum H, Schlaich M, et al. Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2 randomized, controlled trial[J]. Circulation, 2012, 126(25): 2976-2982.
18. Krum H, Schlaich MP, Sobotka PA, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study[J]. Lancet, 2014, 383(9917): 622-629.
19. Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant hypertension[J]. N Engl J Med, 2014, 370(15): 1393-1401.
20. B?hm M, Kario K, Kandzari DE, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial[J]. Lancet, 2020, 395(10234): 1444-1451.
21. Kandzari DE, B?hm M, Mahfoud F, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial[J]. Lancet, 2018, 391(10137): 2346-2355.
22. Mahfoud F, Kandzari DE, Kario K, et al. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial[J]. Lancet, 2022, 399(10333): 1401-1410.
23. Kandzari DE, Mahfoud F, Townsend RR, et al. Long-term safety and efficacy of renal denervation: 24-month results from the SPYRAL HTN-ON MED trial[J]. Circ Cardiovasc Interv, 2025, 18(7): e015194.
24. Azizi M, Sanghvi K, Saxena M, et al. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial[J]. Lancet, 2021, 397(10293): 2476-2486.
25. Azizi M, Schmieder RE, Mahfoud F, et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial[J]. Lancet, 2018, 391(10137): 2335-2345.
26. Azizi M, Saxena M, Wang Y, et al. Endovascular ultrasound renal denervation to treat hypertension: the RADIANCE II randomized clinical trial[J]. JAMA, 2023, 329(8): 651-661.
27. Mahfoud F, B?hm M, Schmieder R, et al. Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the global Symplicity registry[J]. Eur Heart J, 2019, 40(42): 3474-3482.
28. Bhatt DL, Vaduganathan M, Kandzari DE, et al. Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised Symplicity HTN-3 trial[J]. Lancet, 2022, 400(10361): 1405-1416.
29. Schlaich MP, Mahfoud F, B?hm M, et al. Renal denervation in patients with moderate to severe chronic kidney disease[J]. Hypertension, 2025, 82(12): 2252-2261.
30. Reyes KRL, Rader F. Long-term safety and antihypertensive effects of renal denervation: current insights[J]. Integr Blood Press Control, 2023, 16: 59-70.
31. Persu A, Sapoval M, Azizi M, et al. Renal artery stenosis following renal denervation: a matter of concern[J]. J Hypertens, 2014, 32(10): 2101-2105.
32. Patel HC, Hayward C, Vassiliou V, et al. Renal denervation for the management of resistant hypertension[J]. Integr Blood Press Control, 2015, 8: 57-69.
33. Zweiker D, Lambert T, Steinwender C, et al. Effects of renal denervation documented in the Austrian national multicentre renal denervation registry[J]. PLoS One, 2016, 11(8): e0161250.
34. Moriarty JM, Tung R, Bradfield JS, et al. Renal denervation: a novel therapy at the crossroads of imaging, intervention, and innovation[J]. J Lab Autom, 2016, 21(2): 312-316.
35. Mohammad AA, Nawar K, Binks O, et al. Effects of renal denervation on kidney function in patients with chronic kidney disease: a systematic review and meta-analysis[J]. J Hum Hypertens, 2024, 38(1): 29-44.
36. Ott C, Mahfoud F, Schmid A, et al. Improvement of albuminuria after renal denervation[J]. Int J Cardiol, 2014, 173(2): 311-315.
37. Yamazaki D, Konishi Y, Kitada K. Effects of renal denervation on the kidney: albuminuria, proteinuria, and renal function[J]. Hypertens Res, 2024, 47(10): 2659-2664.
38. 李月平, 盧成志, 蔣雄京, 等. 經皮去腎神經術治療高血壓中國專家科學聲明[J]. 中國介入心臟病學雜志, 2023, 31(12): 881-893.
39. Barbato E, Azizi M, Schmieder RE, et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC council on hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)[J]. Eur Heart J, 2023, 44(15): 1313-1330.
40. Mancia G, Kreutz R, Brunstr?m M, et al. 2023 ESH guidelines for the management of arterial hypertension the task force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)[J]. J Hypertens, 2023, 41(12): 1874-2071.
41. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines[J]. J Am Coll Cardiol, 2025, 86(18): 1567-1678.
42. McCarthy CP, Bruno RM, McEvoy JW, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: what is new in pharmacotherapy?[J]. Eur Heart J Cardiovasc Pharmacother, 2025, 11(1): 7-9.
43. 國家放射與治療臨床醫學研究中心, 蘇州工業園區東方華夏心血管健康研究院高血壓介入治療工作委員會, 《經皮去腎神經術治療高血壓臨床路徑中國專家共識(2025 版)》專家組, 等. 經皮去腎神經術治療高血壓臨床路徑中國專家共識(2025 版)[J]. 中國介入心臟病學雜志, 2025, 33(9): 481-490.

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