Recent advances in the approach to catheter-based renal denervation

INTRODUCTION: Renal denervation is an interventional approach for the reduction of blood pressure with sustained and clinically relevant outcomes in clinical trials. Ablation of the renal nerves reduces sympathetic efferent and sensory afferent nerve traffic responsible for BP elevation. AREAS COVERED: This review provides an overview of hypertension pathophysiology, the development and ongoing refinement of renal denervation techniques, as well as the role of patient selection for outcomes and other conditions which may benefit from RDN. A non-systematic review of Medline and Scopus was performed from 1 June 2025 to 1 March 2026. EXPERT OPINION: Sham-controlled clinical trials have proven that RDN results in a clinically relevant and durable blood pressure reduction in patients with difficult-to-control and resistant hypertension, either on or off concomitant antihypertensive treatment. The procedure has a favorable safety profile. The introduction of novel RDN systems utilizing ultrasound ablation and chemically mediated denervation has continued to advance the field and further corroborate the principles of RDN. Whether there is superiority of a particular systems remains an open question and will be an ongoing research focus. Procedural improvements and the role of renal nerve stimulation to guide subsequent ablation show promise to further enhance outcomes for patients.