AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Real-World Blood Pressure Control and Safety After Renal Denervation for Uncontrolled Hypertension
By Chowdhary R, Futela P, Rosenzveig A et al.
Background: Renal denervation (RDN) has re-emerged as a catheter-based device therapy for patients with uncontrolled hypertension following the landmarks SPYRAL HTN-OFF MED and SPYRAL HTN-ON MED sham-controlled trials, which demonstrated significant office and ambulatory systolic blood pressure (BP) reductions independent of antihypertensive medication. Despite this regulatory milestone, contemporary real-world data characterizing BP trajectory and post-procedural safety remain limited to highly selected trial populations, leaving critical gaps in understanding RDN effectiveness in heterogeneous clinical practice. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults ≥18 years with a hypertension diagnosis and objective evidence of elevated BP (SBP ≥140 mmHg or DBP ≥90 mmHg) at the index RDN date were included. RDN was identified using CPT, HCPCS, ICD-10-PCS, and SNOMED codes. BP control was defined as SBP <140 mmHg and DBP ≤90 mmHg, analyzed separately. The index event was the first qualifying RDN procedure per patient. Safety outcomes included MACE (all-cause mortality, acute MI, or ischemic stroke), incident hospitalization, and renal and bleeding complications. Outcomes were assessed at 30 days, 6 months, and 1 year using risk analysis and Kaplan-Meier survival methods; patients with prior occurrence of each outcome were excluded from that analysis. Results: BP control improved rapidly following renal denervation and was sustained throughout follow-up. Among 529 adults undergoing RDN across 32 healthcare organizations, systolic BP control (SBP <140 mmHg) increased from 43.2% at 30 days to 68.1% at 1 year, representing a 25-percentage-point absolute and 58% relative improvement. Diastolic BP control (DBP ≤90 mmHg) increased from 56.5% to 77.7% over the same period. Improvements were evident within weeks of the procedure, with median time to BP control was 20-24 days (diastolic) and 42-54 days (systolic). At 1 year, MACE occurred in 3.3% of eligible patients, with 95.3% Kaplan-Meier event-free survival; renal and bleeding complications were below reportable thresholds, consistent with very low event rates. Conclusions: In this large multicenter real-world cohort, RDN was associated with rapid, durable, and clinically meaningful improvements in BP control: more than two-thirds of patients achieved systolic control and nearly four-fifths achieved diastolic control by 1 year. These findings extend the efficacy observed in sham-controlled trials to a broader, less-selected clinical population. MACE rates were low and renal and bleeding complications exceedingly rare, providing reassuring post-market safety data and supporting catheter-based RDN as an adjunctive treatment strategy for uncontrolled hypertension, one of the largest contemporary real world evaluations following regulatory approval.