{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T17:10:02Z","timestamp":1788801002580,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Hypertension remains the leading modifiable cause of cardiovascular death, yet fewer than one in four treated adults achieves guideline-recommended blood pressure targets. Catheter-based renal denervation interrupts efferent and afferent renal sympathetic signalling and lowers blood pressure continuously and independently of medication adherence. After a decade of controversy following the neutral SYMPLICITY HTN-3 trial, a coherent body of second-generation sham-controlled randomised evidence, generated with radiofrequency, endovascular ultrasound, and perivascular alcohol platforms, has established a reproducible, modest, and durable antihypertensive effect with a favourable safety profile. Between 2024 and 2026, the field crossed three thresholds simultaneously: guideline endorsement on both sides of the Atlantic, including the first United States recommendation in the 2025 AHA\/ACC guideline; a national coverage determination with coverage with evidence development; and the maturation of randomised and real-world follow-up to three years in cohorts exceeding 3000 patients. This state-of-the-art review synthesises the contemporary evidence base; quantifies the expected treatment effect and its heterogeneity; appraises safety across renal and vascular domains; examines emerging data in chronic kidney disease, diabetes, heart failure, and atrial fibrillation; and details the practical requirements for delivering renal denervation responsibly. We conclude by defining the research agenda that must now be addressed: the identification of responders, the development of an intraprocedural endpoint, a direct comparison with newly approved pharmacotherapy, and evidence of cardiovascular event reduction.<\/jats:p>","DOI":"10.3390\/jcdd13090443","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:30:02Z","timestamp":1788798602000},"page":"443","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Catheter-Based Renal Denervation in Uncontrolled and Resistant Hypertension: Evidence, Guidelines, Special Populations and Clinical Implementation"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4374-0389","authenticated-orcid":false,"given":"Ioannis","family":"Skalidis","sequence":"first","affiliation":[{"name":"Department of Cardiology, HFR\u2014Fribourg Cantonal Hospital and University, 1708 Fribourg, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7966-9174","authenticated-orcid":false,"given":"Leonidas","family":"Koliastasis","sequence":"additional","affiliation":[{"name":"Unit of Structural and Valvular Heart Diseases, First Department of Cardiology, National and Kapodestrian University of Athens, General Hospital of Athens \u201cHippokration\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0736-4942","authenticated-orcid":false,"given":"Panayotis K.","family":"Vlachakis","sequence":"additional","affiliation":[{"name":"Unit of Structural and Valvular Heart Diseases, First Department of Cardiology, National and Kapodestrian University of Athens, General Hospital of Athens \u201cHippokration\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2616-7952","authenticated-orcid":false,"given":"Anastasios","family":"Apostolos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, Harefield Hospital, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8215-427X","authenticated-orcid":false,"given":"Maria","family":"Bozika","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3320-408X","authenticated-orcid":false,"given":"Kassiani-Maria","family":"Nastouli","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9092-4458","authenticated-orcid":false,"given":"Nicolas","family":"Amabile","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8960-7006","authenticated-orcid":false,"given":"Philippe","family":"Garot","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-9185","authenticated-orcid":false,"given":"Thomas","family":"Hovasse","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, Institut Cardiovasculaire Paris-Sud, H\u00f4pital Jacques Cartier, 91300 Massy, 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