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Renal Denervation Evidence — EECC MCQ

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ModerateHypertension & Preventive CardiologyRenal Denervation EvidenceEECC

A 65-year-old man with resistant hypertension (office BP 165/100 mmHg on 4 drugs at adequate doses with confirmed adherence by pill counting and drug level testing) is considered for renal denervation. What is the current evidence?

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Correct answer: E — Renal denervation (catheter-based ablation of renal sympathetic nerves) has shown modest BP reductions (5-10 mmHg systolic) in sham-controlled trials (SPYRAL HTN-ON MED, RADIANCE-HTN) — it is a Class IIb option in selected patients with truly resistant hypertension at experienced centres

Renal denervation targets the sympathetic nerves within the renal artery adventitia using catheter-delivered radiofrequency or ultrasound energy, reducing sympathetic drive to the kidneys and systemically. Evidence evolution: (1) SYMPLICITY HTN-3 (2014): first sham-controlled trial — failed to meet primary endpoint, dampening enthusiasm; (2) SPYRAL HTN-ON MED and RADIANCE-HTN TRIO/SOLO: subsequent well-designed sham-controlled trials showing significant 24-hour SBP reductions of 5-10 mmHg; (3) meta-analyses confirm modest but consistent BP reduction. The 2024 ESC Hypertension Guidelines include renal denervation as Class IIb for: truly resistant hypertension (confirmed by ABPM, adherence testing, exclusion of secondary causes) despite optimal ≥4-drug therapy, at experienced centres. It is not a replacement for pharmacotherapy.

Reference: ESC (2024): Hypertension Guidelines; SPYRAL/RADIANCE Trials