Renal Sympathetic Denervation in the Management of Resistant Hypertension: Current Evidence and Perspectives
DOI:
https://doi.org/10.36557/2674-9432.2026v5n1p1812-1830Keywords:
Resistant Arterial Hypertension, Renal Sympathetic Denervantion, Renal Sympathetic Nervous SystemAbstract
Resistant arterial hypertension (RAH) is a clinically significant condition associated with a markedly increased risk of cardiovascular complications and mortality. It affects 10–20% of hypertensive patients and is defined by persistently elevated blood pressure despite the use of three antihypertensive drug classes at appropriate doses, including a diuretic. Its pathophysiology is multifactorial, with a prominent role of renal sympathetic nervous system hyperactivity, contributing to sodium retention, renin-angiotensin-aldosterone system activation, and increased peripheral vascular resistance. In this context, renal sympathetic denervation (RSD) has emerged as a minimally invasive therapeutic strategy capable of modulating neurohumoral blood pressure control. Evidence from recent clinical trials, such as SPYRAL, RADIANCE, and the Global SYMPLICITY Registry, demonstrates consistent and sustained reductions in blood pressure with a favorable safety profile. However, divergent results, like those from the SYMPLICITY HTN-3 study, highlight the need for further investigation. Although not yet established as a standard therapy, RSD is a promising alternative for the management of RAH, particularly in patients refractory to optimized pharmacological treatment.
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