Abstract
BACKGROUND: Resistant hypertension (RH) remains a major therapeutic challenge, affecting 12-18 % of treated hypertensive patients and associated with increased cardiovascular risk. Renal denervation (RDN) has emerged as a promising therapeutic option following initially mixed results. OBJECTIVE: This review analyzes the evolution of RH management, from its definition to new therapeutic perspectives offered by RDN, based on recent international guidelines (ESH 2023, ESC 2024, ACC/AHA 2025). METHODS: Critical analysis of pivotal clinical trials, recent meta-analyses, and international registries evaluating the efficacy and safety of RDN in RH. RESULTS: Recent trials (SPYRAL HTN-ON/OFF MED, RADIANCE-HTN TRIO) demonstrate moderate but significant efficacy of RDN, with systolic blood pressure reductions ranging from 3.9 to 18.7 mmHg depending on populations. Technological advances (multi-electrode catheters, distal branch targeting) improve outcomes. The safety profile appears favorable with low complication rates. CONCLUSIONS: RDN represents an emerging therapeutic option for RH, now recommended by European societies for specific indications. Rigorous patient selection and performance in experienced centers remain essential.