Resistant Hypertension (RH) is characterized by uncontrolled blood pressure despite the use of three or more optimally dosed antihypertensive agents, including a diuretic, and affects approximately 10%-30% of treated hypertensive individuals. This condition substantially elevates cardiovascular risk and is primarily driven by heightened sympathetic nervous system activity. Catheter-based Renal Denervation (RDN) offers a minimally invasive strategy aimed at ablating renal sympathetic nerves, potentially improving blood pressure control.

A comprehensive literature searches up to October 2025 identified six high-quality, sham-controlled randomized trials encompassing 1,448 patients. These studies demonstrate significant reductions in 24-hour ambulatory systolic blood pressure (-4.4 mmHg) and office systolic blood pressure (-5.2 mmHg) following RDN compared to sham treatment. RDN was generally well tolerated, with a favorable safety profile and preservation of renal function.

Collectively, catheter-based RDN provides clinically meaningful blood pressure reductions alongside a decreased medication burden in resistant hypertension. Longer-term follow-up studies are needed to validate sustained efficacy and cardiovascular benefits.