Percutaneous Renal Denervation for Resistant Hypertension in a High-Risk Real-World Population: Preliminary Results From a Prospective Single-Center Experience

Renal denervation (RDN) is an adjunctive treatment for selected patients with resistant hypertension. We report the preliminary effectiveness and safety of radiofrequency RDN in a high-risk real-world population. This prospective, observational, single-center study enrolled 18 patients who underwent bilateral RDN using the Symplicity Spyral system. All had baseline office systolic BP (SBP) > 155 mmHg and diastolic BP > 90 mmHg despite at least three antihypertensive drugs at the maximum tolerated doses. Clinical response required both an office SBP reduction ≥ 10 mm Hg and a mean 24-h ambulatory SBP reduction ≥ 5 mm Hg. Outcomes were assessed within 72 h and at 1 month. All procedures were technically successful. At 72 h, 15 patients (83.3%) met both response criteria; all had an office SBP reduction ≥ 20 mm Hg. At 1 month, 16 (88.9%) were responders and 2 (11.1%) were nonresponders. Among responders, five discontinued one drug and continued dual therapy, whereas 11 continued three drugs at reduced doses. Procedural events included one iatrogenic renal artery dissection, one femoral artery dissection with perforation, one guidewire fracture successfully retrieved with an endovascular snare, and two femoral hematomas. Renal function did not deteriorate. In conclusion, radiofrequency RDN was technically feasible and was followed by an early clinical response in most patients. The small sample, short follow-up, and absence of a control group preclude definitive efficacy conclusions.