Renal denervation in treatment-resistant hypertension: a reappraisal.

The Symplicity HTN-1 and 2 studies proposed renal denervation (RDN) as an effective and safe approach to treat patients with resistant hypertension, and were followed by an unprecedented wave of enthusiasm. The announcement that Symplicity HTN-3 failed to meet its primary efficacy endpoint put an abrupt stop to these overoptimistic expectations. The use of a sound methodology was enough to see the typical 25-30mmHg systolic blood pressure decrease observed after RDN melt down to <3mmHg. RDN certainly deserves further investigation but is not ready for wide clinical application. For the time being, physicians should focus on improvement of drug adherence and skilful drug treatment adjustment, which allow reaching blood pressure target in the large majority of hypertensive patients.