Hypertension is a chronic elevation of arterial blood pressure, which is in most cases asymptomatic but represents the most common modifiable cardiovascular risk factor. It is a major cause of morbidity and mortality due to its association with coronary artery disease, acute myocardial infarction, stroke, heart failure, and life-threatening arrhythmias such as atrial fibrillation. Hypertension is often undiagnosed and, even when identified, frequently undertreated. It is estimated that approximately 70% of individuals over the age of 60 are hypertensive (defined as blood pressure above 130/80 mm Hg according to the European and American Cardiology Societies).
Until recently, the therapeutic approaches for arterial hypertension have been primarily based on lifestyle modifications and pharmacological therapy. However, in approximately 20% of hypertensive patients, blood pressure cannot be adequately controlled despite the use of up to four antihypertensive medications. Recently, the interventional treatment of hypertension through renal artery denervation has emerged as an effective option for managing resistant hypertension.
The procedure is performed endovascularly in a cardiac catheterization laboratory using a specialized catheter. The catheter is introduced via femoral artery puncture under local anesthesia to gain access to the renal arteries. It is connected to a generator of either radiofrequency energy or ultrasound, enabling ablation of the renal sympathetic nerves transarterially through the lumen of the main renal artery. The catheter is inserted into each renal artery, and several discrete radiofrequency energy deliveries (each lasting ≤2 minutes) are applied to achieve 3–4 ablation points, both longitudinally and circumferentially along each renal artery. After completion, the catheter is withdrawn, and the patient is transferred to the recovery room. Hospital discharge typically occurs the following day.
The procedure is technically straightforward, with minimal reported complications. Moreover, it is currently being evaluated as a therapeutic option for heart failure and certain arrhythmias.
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