Kidney Week 2025 Annual Meeting-Advancing Hypertension Care: Role of Renal Denervation

Video Transcription

Video Summary

This session reviewed the rationale, mechanisms, evidence, and clinical implementation of renal denervation (RDN) for hypertension. Dr. Raven Vora explained that hypertension—especially resistant hypertension—is characterized by increased sympathetic nervous system activity, measurable via norepinephrine spillover and muscle sympathetic nerve activity. The kidneys both send afferent signals that increase central sympathetic outflow and receive efferent signals that promote RAAS activation, sodium retention, and vasoconstriction. RDN is a catheter-based procedure that ablates peri-arterial renal sympathetic nerves (via radiofrequency, ultrasound, or chemical alcohol). Trials show RDN reduces sympathetic activity and lowers office and ambulatory systolic BP modestly within months, with durable reductions out to three years. Animal (pig) data show early nerve destruction, reduced renal norepinephrine, and fibrosis with distal nerve atrophy, supporting sustained effects and limited functional regrowth. Key unmet needs include identifying responders (about two-thirds respond) and practical biomarkers of sympathetic overactivity.<br /><br />Dr. Omar Al-Dabi focused on patient selection: rule out white-coat and secondary hypertension, assess adherence, and choose candidates with uncontrolled/resistant hypertension, medication intolerance/nonadherence, hypertensive crises/ER visits, or evidence of sympathetic drive (high resting HR, orthostatic hypertension, non-dipping on ABPM). Response improves with more ablations and may synergize with mineralocorticoid antagonists; isolated systolic hypertension is generally off-label. Contraindications include renal artery stenosis, unsuitable anatomy, FMD, aneurysm, single kidney, pregnancy, and transplant.<br /><br />Dr. Vivek Bhalla described operational requirements for coverage (CMS): structured hypertension programs, longitudinal management, specialist access, ABPM/home BP documentation, secondary cause evaluation (notably primary aldosteronism), and follow-up imaging (often ultrasound at ~6 months). Dr. Debbie Cohen presented real-world cases showing improved BP stability, reduced medication burden in some, and incremental BP lowering over time, emphasizing safety, durability, and shared decision-making.

Asset Subtitle

Moderator(s): Karen Griffin, Matthew Weir

Presentation(s):

Mechanisms and Science of Renal Denervation: Translating to Clinical Practice - Raven Voora
Patient Selection for Renal Denervation and Clinical Challenges - Omar Al Dhaybi
Screening Patients and Follow-Up Plans - Vivek Bhalla
Patient Case Studies - Debbie Cohen

Support for this session is provided by an educational grant from Medtronic.

Meta Tag

Date 11/7/2025

Pathway 1 Hypertension and Cardiorenal Disorders

Session ID 504400

Keywords

renal denervation

RDN

hypertension

resistant hypertension

sympathetic nervous system overactivity

renal sympathetic nerves

norepinephrine spillover

muscle sympathetic nerve activity

RAAS activation

ambulatory blood pressure monitoring

office and ambulatory systolic BP reduction

radiofrequency ablation

ultrasound ablation

alcohol chemical ablation

patient selection and contraindications