Renal Denervation Revisited: A Safer Path to Blood Pressure Control With Deepak L. Bhatt, MD, MPH, MBA

On the final day of the ASPC 2025 Congress on CVD Prevention, Deepak L. Bhatt, MD, MPH, MBA, FACC, FAHA, FESC, MSCAI, Mount Sinai Fuster Heart Hospital, closed out the meeting with an in-depth look at renal denervation, a minimally invasive procedure that uses radiofrequency or ultrasound energy to disrupt nerve signals, and its impact on patients with hypertension.

Previous surgical iterations of the procedure, he explains, “the side effects were worse than the actual disease… profound orthostatic hypotension, erectile dysfunction, bowel and bladder incontinence in many cases,” whereas newer and FDA-approved catheter-based approaches are beneficial and safe. Also, although the blood pressure reductions seen in rigorous clinical trials are modest, the procedure offers a promising option for patients with resistant hypertension.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What is renal denervation and how does this procedure work to reduce hypertension and its impact?

It was really an honor to speak here at the American Society for Preventive Cardiology and to have the final lecture in the hypertension section and, in fact, in the whole meeting, was really quite nice. The topic I spoke about was renal artery denervation, and this is a minimally invasive technique typically done through access via the femoral artery, although in the future I imagine this will be the radial artery. What it involves is taking the catheter to the renal artery and then applying energy to that artery to denervate it from the inside.

Basically, from an interventional perspective, it's somewhat similar to renal artery angiography, but then taking a device percutaneously into that artery and denervating it. Right now, it's radio frequency energy that's used, but in the future, there could be other ways as well. There are people who are studying alcohol injection, for example, via a balloon with little needles.

The principle is really denervation, but right now it's radio frequency. There are 2 predominant ways of doing that in the US that are FDA approved. One involves a spiral catheter and the other one involves a balloon catheter that is emitting ultrasound, so an ultrasound-based denervation approach and a radio frequency–based approach on spiral electrode catheter. Those are 2 different ways of doing it. As I mentioned, there are other ways as well, not yet approved in the US.

There's really a long history of renal artery denervation going back decades, where surgical sympathectomy was done for people with out-of-control blood pressure and there was no question that the procedure worked. They went from totally out-of-control blood pressure to having normal blood pressure—a huge success. But the problem was that the side effects were worse than the actual disease was. That is, patients were left with profound orthostatic hypotension, they were left with erectile dysfunction, with bowel and bladder incontinence in many cases. The cure was worse than the disease in many cases. Then things like mercurial diuretics and other things came on the scene back then and the procedure was abandoned. But then in the 90s, it was investigated again in animals and other preclinical models with a catheter-based approach, and then now, a couple of decades after that, there are actually FDA-approved devices that can be used to denervate the artery, producing rather modest reductions in blood pressure—at least in the randomized controlled trials that have been done rigorously—but without the side effects from that surgical experience decades ago.