Renal Denervation: From Historical Roots to the Modern Therapeutic Paradigm

Hypertension is a leading risk factor for cardiovascular morbidity and mortality. Despite the availability of effective medications and lifestyle interventions, blood pressure control rates remain poor globally, and the prevalence of hypertension continues to rise. In 2023, the US Food and Drug Administration approved renal denervation—a catheter-based procedure that ablates the renal sympathetic nerves—as an adjunctive treatment for patients with uncontrolled or resistant hypertension, defined as blood pressure above goal despite the use of at least three antihypertensive medications, including a diuretic at maximally tolerated doses. Both radiofrequency and ultrasound-based devices are approved for this procedure. However, individual patient responses vary, and further research is needed to clarify long-term efficacy, safety, and optimal patient selection. The number of trained proceduralists and access to facilities is increasing, but multidisciplinary teams and shared decision-making are recommended to ensure appropriate referrals and patient education. In this review, we discuss the pathophysiology of hypertension and approaches to treatment, review the history of renal denervation and the data on which FDA approval was based, detail the safety profile of commercially available devices, and provide a practical, team-based approach to appropriate patient selection.