Renal denervation for hypertension management: convergence and divergence across international guidelines

All three guidelines converge on four major indications: uncontrolled hypertension, resistant hypertension, drug intolerance, and patient preference. Key divergences relate to the strength of recommendations and specific patient selection criteria. Although differences in recommendation classes (ACC/AHA 2b vs. ESC/ESH IIb) appear discordant, they largely reflect structural variations in grading frameworks rather than genuine differences in evidence appraisal. The modest expected blood pressure reduction (4-6 mmHg ambulatory systolic), equivalent to approximately one antihypertensive medication, translates into an estimated 10% reduction in major cardiovascular events, though individual responses vary considerably. RDN represents a complementary therapeutic option requiring multidisciplinary evaluation and shared decision-making.