Renal Denervation with Ultrasound for Resistant Hypertension: A New Therapeutic Approach

Abstract

This article reviews ultrasound-based renal denervation as a therapeutic approach for resistant hypertension, defined as blood pressure that remains above target despite three or more antihypertensive medications of different classes, including a diuretic. It describes how overactivity of the renal sympathetic nerves contributes to resistant hypertension through sodium and water retention, activation of the renin-angiotensin-aldosterone system, catecholamine release and reduced renal blood flow, and explains the principle of renal denervation, a minimally invasive procedure that disrupts the sympathetic nerve fibres along the renal arteries. Unlike radiofrequency ablation, the ultrasound technique delivers energy circumferentially through a catheter inserted via the femoral artery, creating a uniform thermal field that may improve the consistency of nerve disruption while limiting damage to the arterial wall. The article summarises evidence from the RADIANCE-HTN SOLO, RADIANCE-HTN TRIO and SPYRAL HTN-OFF MED trials and outlines the reported benefits, including sustained reductions in systolic and diastolic blood pressure and reduced medication use, as well as potential complications such as vascular injury, renal impairment and incomplete denervation. Indications, patient selection and future research directions are also discussed. The authors conclude that ultrasound-based renal denervation is not a first-line treatment but offers sustained blood pressure reduction as an adjunct or alternative to drug therapy, particularly for patients who respond inadequately to, or cannot tolerate, antihypertensive medications.

Abstract prepared by the editorial office from the full text of the article; the authors did not supply one.