An expert consensus statement on renal denervation for the management of hypertension endorsed by the Portuguese Association of Interventional Cardiology of the Portuguese Society of Cardiology (APIC-SPC) and the Portuguese Society of Hypertension (SPH)

Abstract

This national expert consensus statement, endorsed by the Portuguese Association of Interventional Cardiology of the Portuguese Society of Cardiology (APIC-SPC) and the Portuguese Society of Hypertension (SPH), provides practical guidance on the appropriate use of renal denervation for blood pressure management in adults with uncontrolled hypertension in spite of optimally tolerated guideline-directed therapy and lifestyle measures. It synthesizes evidence from contemporary sham-controlled trials and large real-world registries, which show sustained blood pressure reductions with both radiofrequency and ultrasound systems, and a favorable and consistent safety profile, while acknowledging remaining uncertainties in long-term clinical outcomes and individual response prediction. The document emphasizes rigorous patient selection within a structured pathway coordinated by multidisciplinary hypertension teams. It outlines organizational requirements for centers performing renal denervation, key elements of pre-procedural imaging and peri-procedural management, and a standardized follow-up strategy using office, home, and ambulatory monitoring to enable timely therapy adjustment. Beyond resistant hypertension, this statement discusses carefully selected scenarios in which RDN may be considered as an adjunctive option, while reinforcing that renal denervation is not first-line therapy and should be integrated into a comprehensive hypertension care. This consensus aims to clarify for which patients renal denervation may be a viable therapeutic option, identify the main clinical and procedural considerations for its implementation, and promote its optimal and safe use through appropriate patient selection and multidisciplinary evaluation.