Resistant hypertension continues to pose a major
challenge to clinicians worldwide and has serious
implications for patients who are at increased risk of
cardiovascular morbidity and mortality with this
diagnosis. Pharmacological therapy for resistant
hypertension follows guidelines-based regimens although
there is surprisingly scant evidence for beneficial
outcomes using additional drug treatment after three
antihypertensives have failed to achieve target blood
pressure. Recently there has been considerable interest in
the use of endoluminal renal denervation as an
interventional technique to achieve renal nerve ablation
and lower blood pressure. Although initial clinical trials
of renal denervation in patients with resistant
hypertension demonstrated encouraging office blood
pressure reduction, a large randomised control trial
(Symplicity HTN-3) with a sham-control limb, failed to
meet its primary efficacy end point. The trial however
was subject to a number of flaws which must be taken
into consideration in interpreting the final results.
Moreover a substantial body of evidence from nonrandomised
smaller trials does suggest that renal
denervation may have an important role in the
management of hypertension and other disease states
characterised by overactivation of the sympathetic
nervous system. The Joint UK Societies does not
recommend the use of renal denervation for treatment of
resistant hypertension in routine clinical practice but
remains committed to supporting research activity in this
field. A number of research strategies are identified and
much that can be improved upon to ensure better
design and conduct of future randomised studies.