Which patient should have renal denervation in 2026?

The first question I'd like to address you is what does the guidelines say regarding the application of the therapy in current practice?

I think there has been a very important revolution or evolution in the recent years coming from the 2018 guidelines not really endorsing renal denervation and now all major guidelines and a lot of national guidelines or documents really endorse renal denervation for patients with uncontrolled resistant hypertension.

including taking a pharmacotherapy compounds, including a diuretic, with an EGFR of 40 or above, and with an exclusion of secondary hypertension and pseudoresistance.

So it is broadened, but still the evidence I think behind it is wider than that.

So if you see what the guidelines propose as the ideal candidate, is that also in your practice the candidate that you always take for renal denervation?

Well, we have a long experience with renal denervation and I have to admit that the guidelines, the European guidelines, are a little bit restrictive compared to our daily practice that has been evolving with experience and results.

And I have to say that we have understood that the younger the patient, the better the effects and of course, theoretically, the most important reduction of events along time.

We have to target those who are considered high risk for vascular events.

So these are diabetic patients, patients without control with previous clinical events, but above all, patients with chronic kidney disease.

We know that patients with renal disease are those with most difficult to treat hypertension.

And in our group, we specifically focused on that kind of patients and we understood that probably they are among those who benefit most from renal denervation because it's easier to control blood pressure and a data that needs to be validated but it's coming out from different experiences it prevents the long-term renal damage associated with uncontrolled blood pressure so that makes of this group that has been unfortunately excluded from the guidelines when the GFR is before 40, probably the most likely to benefit from this therapy.