Comparing renal denervation versus pharmacological optimization in uncontrolled hypertension

Uncontrolled hypertension persists as a major cardiovascular threat in Uzbekistan, where resistant cases challenge standard pharmacological approaches. This prospective randomized controlled trial, conducted at the Republican Specialized Scientific-Practical Medical Center of Cardiology in Tashkent from January 2024 to December 2025, compared renal denervation (RDN) versus pharmacological optimization (PO) in 120 adults with office SBP ≥160 mmHg despite triple therapy. Patients were randomized 1:1; RDN used Symplicity Spyral™ ablation, while PO involved up-titration to five agents. Primary endpoint was 12-month change in 24-hour ambulatory SBP. Baseline traits were balanced (mean age 59 years, SBP 172 mmHg). RDN yielded a -30.5 mmHg SBP drop versus -16.6 mmHg for PO (between-group difference -13.2 mmHg, 95% CI -18.1 to -8.3, P<0.001), with superior responder rates (82% vs. 52%, P<0.001) and control (<130/80 mmHg: 58% vs. 27%). Drug burden fell to 2.8 versus 4.6 agents (P<0.001), with quality-of-life gains (+0.12 vs. +0.05 EQ-5D, P=0.002). Safety was comparable (serious AEs: 9% vs. 13%). RDN shows marked efficacy and simplification in this real-world Uzbek cohort, supporting its role in resistant hypertension management amid local constraints. These findings urge guideline updates for device therapies in Central Asia.