StatPearls Publishing, Treasure Island · Jan 10, 2026
Renal Denervation Therapy for Drug-Resistant Hypertension
By Leslie SW, Rader F, Toggweiler S et al.
Hypertension remains the single most significant worldwide health problem, affecting about a third of the entire global population and accounting for the largest number of preventable deaths, disproportionately affecting low and middle-income countries. Only about a fifth of affected individuals have their blood pressures well controlled. At least 10% of all patients with hypertension worldwide will have true drug-resistant disease, once secondary causes, medication intolerance, and treatment compliance issues have been excluded. For this challenging group of patients, renal denervation therapy offers a promising, durable, complementary therapeutic option that can significantly reduce elevated systolic blood pressures in at least two-thirds of those treated. Innervation of the kidneys includes both afferent and efferent fibers of the renal plexus. This plexus is a combination of fibers originating from the celiac plexus, aorticorenal ganglia, the intermesenteric plexus, the lumbar, and the least splanchnic nerves. Nerves from these plexuses attach along the renal artery and vein to enter the kidney. Afferent innervation is essential for the recognition of nociception. Little evidence exists for parasympathetic fibers or activity in the kidney, but anatomical findings include cholinergic axons in the main renal arteries, segmental arteries, and the renal pelvis. Hypertension is associated with increased renal sympathetic nerve activity, which causes the kidneys to reabsorb more sodium and water, restricts renal arterial perfusion by promoting vasoconstriction, reduces glomerular filtration rate, and raises serum renin levels, collectively increasing blood pressure. Chronic sympathetic overactivity may also result in progressive renal impairment and cardiac hypertrophy. Renal denervation therapy offers a unique, durable, and effective treatment that may help reduce the morbidity and mortality of otherwise uncontrollable hypertension, although cardiovascular outcomes trials are lacking.