Renal Denervation for Uncontrolled Hypertension

Key Messages

What Is the Issue?

• It is estimated that 23% of adults in Canada have hypertension. About 1/3 of this population have uncontrolled hypertension, a condition in which (BP) blood pressure levels continue to remain high despite treatment. People with high BP despite being prescribed 3 or more blood pressure-lowering (antihypertensive) medicines are considered to have uncontrolled resistant hypertension.
• Renal denervation is a therapy that involves disrupting activity in the sympathetic nerves in the renal artery using a minimally invasive catheter-based procedure to treat high BP.
• We wanted to know if renal denervation would effectively and safely reduce BP in people with uncontrolled hypertension.

What Did We Do?

• We identified and summarized the literature comparing the clinical effectiveness and safety of renal denervation in individuals with uncontrolled hypertension to help guide decisions on the use of this intervention.
• An information specialist searched for peer-reviewed and grey literature sources published between January 1, 2019, and February 5, 2024. The search was limited to English-language documents. One reviewer screened articles for inclusion based on predefined criteria, critically appraised the included studies, and narratively summarized the findings.

What Did We Find?

• The evidence for this report was based on 2 systematic reviews and 3 randomized controlled trials (RCTs).
• Renal denervation could lead to a reduction in BP compared to sham in adults with uncontrolled nonresistant hypertension.
• It is uncertain if renal denervation is an effective treatment for resistant hypertension and suspected hypertensive heart disease due to the methodological limitations of the included studies.
• Serious side effects of renal denervation were rare.

What Does This Mean?

• Our findings agree with evidence-based guidelines and real-world evidence that suggest renal denervation can be considered a treatment option for patients with uncontrolled nonresistant hypertension. Other factors, including costs and resources, equity, acceptability, and patient selection, should be considered when implementing renal denervation in Canada, where it remains an emerging medical technology.
• Future research should assess important patient outcomes, such as quality of life.