Arterial Hypertension · Published 2026-04-16 · DOI 10.5603/ah.107678
Hypertension is a major global health issue, with resistant hypertension (RH) being one of its most severe forms. RH is characterized by the inability to control blood pressure (BP) despite lifestyle changes and the use of three antihypertensive drugs, including diuretics, at maximum tolerated doses. RH patients face elevated risks for cardiovascular and organ damage, including heart failure, kidney impairment, and stroke. Renal denervation (RDN), a minimally invasive procedure, has emerged as a potential treatment for RH by disrupting renal sympathetic nerves involved in BP regulation, with mechanisms involving radiofrequency and ultrasound-based methods. Multiple clinical trials reveal RDN’s variable efficacy, with some showing significant BP reductions while others do not. Factors influencing RDN outcomes include patient age, race, presence of renal artery atherosclerosis, and comorbid conditions such as diabetes and obesity. Intra-arterial heparin flushing (IAHF) prior to RDN has not been performed before, but it can be a novel technique to optimize RDN effectiveness by addressing anatomical challenges, namely atherosclerosis in the renal arteries. If done optimally, RDN can potentially be cost-saving, particularly in high-risk RH patients, by reducing long-term cardiovascular event costs and medication reliance. In conclusion, RDN with prior IAHF is a promising approach for RH management, offering long-term BP control and economic benefits, though further research is needed to refine patient selection and procedural protocols.
Abstract from DOAJ. Public domain (CC0 1.0).
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