{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:59:59Z","timestamp":1785149999388,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"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. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Resistant hypertension poses a significant therapeutic challenge, often leading to severe polypharmacy. Renal denervation (RDN) has re-emerged as a valuable adjunctive intervention for blood pressure control. Case Presentation: We report the case of a 64-year-old man (body mass index [BMI] 34 kg\/m2) with long-standing resistant hypertension (RH), after previous percutaneous coronary intervention (PCI) to the left anterior descending artery, heart failure with preserved ejection fraction (HFpEF), and prior nephron-sparing surgery for clear cell renal carcinoma. Despite treatment with an extensive antihypertensive regimen encompassing nine pharmacological classes including diuretic therapy (angiotensin-converting enzyme inhibitor; calcium channel blocker, thiazide diuretic, \u03b2-blocker, \u03b11-blocker, central \u03b12-agonist, mineralocorticoid receptor antagonist, loop diuretic, long-acting nitrates), blood pressure remained severely uncontrolled on both home and office measurements. Persistent hypertension was accompanied by exertional dyspnoea and episodes of exertional chest discomfort. Following comprehensive evaluation and exclusion of secondary causes of hypertension, the patient underwent catheter-based renal denervation using the SymplicitySpyral\u2122 (Medtronic) multi-electrode radiofrequency system. The procedure was associated with substantial and sustained improvement in blood pressure control, with mean 24 h ambulatory blood pressure measurements decreasing to 130\/80 mmHg at six-month follow-up. Importantly, successful blood pressure reduction enabled major simplification of pharmacotherapy, including complete discontinuation of clonidine, loop diuretic therapy, and long-acting nitrates, together with marked dose reduction in doxazosin. Conclusions: This case illustrates the potential clinical utility of renal denervation in carefully selected patients with true resistant hypertension and pronounced sympathetic overactivity. Beyond achieving satisfactory blood pressure control, RDN may facilitate meaningful reduction in medication burden, potentially improving treatment adherence, quality of life, and long-term cardiovascular risk. Written informed consent was obtained from the patient for both the procedure and the publication of this case report.<\/jats:p>","DOI":"10.3390\/jcm15155838","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:47:41Z","timestamp":1785145661000},"page":"5838","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Breaking the Cycle of Polypharmacy: A Case Report of Renal Denervation in Resistant Hypertension"],"prefix":"10.3390","volume":"15","author":[{"given":"Maria","family":"Szwarkowska","sequence":"first","affiliation":[{"name":"Centre for Innovative Medical Education, Jagiellonian University Medical College, Medyczna 7, 30-688 Krak\u00f3w, Poland"},{"name":"Students\u2019 Scientific Group of Centre for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krak\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tymoteusz","family":"Petela","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Traugutta 2, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6938-4896","authenticated-orcid":false,"given":"Aleksander","family":"Zelia\u015b","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Science, University of Applied Science in Nowy S\u0105cz, 33-300 Nowy S\u0105cz, Poland"},{"name":"2nd Clinical Department of Cardiology, Faculty of Medicine and Health Science, University of Applied Science in Nowy S\u0105cz, 33-300 Nowy S\u0105cz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1149-7457","authenticated-orcid":false,"given":"Tomasz","family":"Skowerski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0836-1877","authenticated-orcid":false,"given":"Tomasz","family":"Tokarek","sequence":"additional","affiliation":[{"name":"Centre for Innovative Medical Education, Jagiellonian University Medical College, Medyczna 7, 30-688 Krak\u00f3w, Poland"},{"name":"Centre for Invasive Cardiology, Electrotherapy and Angiology, Kili\u0144skiego 68, 33-300 Nowy S\u0105cz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1161\/HYP.0000000000000240","article-title":"Renal Denervation for the Treatment of Hypertension: A Scientific Statement From the American Heart Association","volume":"81","author":"Cluett","year":"2024","journal-title":"Hypertension"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"2024 ESC Guidelines for the management of elevated blood pressure and hypertension","volume":"45","author":"McEvoy","year":"2024","journal-title":"Eur. 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