In these cases, I treat hypertension with renal ablation.

Systemic arterial hypertension is one of the leading causes of mortality and morbidity worldwide. Despite therapeutic advancements, a significant proportion of hypertensive patients fail to achieve adequate blood pressure control. Renal denervation (RDN) is emerging as an innovative and minimally invasive procedure to treat hypertension by modulating the renal sympathetic nervous system. Recent clinical trials, including SYMPLICITY HTN-3, SPYRAL HTN-OFF MED, and RADIANCE-HTN SOLO, have shown variable results, influenced by patient selection and study design. The latest 2024 ESC guidelines on systemic arterial hypertension recommend RDN as a therapeutic option in selected cases, especially in patients with resistant hypertension not adequately controlled by pharmacological therapy. However, the response to this approach varies according to individual pathophysiology and the level of sympathetic activation. This article highlights how RDN, performed using ultrasound or radiofrequency technologies, may represent a breakthrough for difficult-to-treat patients, bridging current therapeutic gaps and reducing long-term cardiovascular risk. Finally, it emphasizes the importance of a multi-disciplinary assessment to maximize the benefits of the procedure.