Renal Denervation for High Blood Pressure: What You Need to Know

“RDN is a valuable treatment option for people whose blood pressure remains uncontrolled despite best attempts at lifestyle modification and despite taking multiple antihypertensive medications,” says Naomi Fisher, MD, an associate professor of medicine at Harvard Medical School and an endocrinologist who serves as director of hypertension services at Brigham and Women’s Hospital.

Renal denervation is not expected to replace someone’s medications and lifestyle modifications, but it could allow certain patients to reduce their medications or dosages. That’s important, says Fisher, who was involved in the trials for the Symplicity Spyral and Paradise systems.

You are not a good candidate for RDN if:

• Your high blood pressure is well controlled with one or two medications.
• You are pregnant.
• You have abnormal kidney tumors.
• You have a certain degree of renal artery stenosis (when the arteries to your kidneys are narrowed).
• You have a renal artery aneurysm.

The 2025 American College of Cardiology/American Heart Association clinical practice guideline states that, for people with resistant hypertension despite optimal treatment, or intolerable side effects to extra medications, renal denervation may be reasonable as a treatment to lower blood pressure, along with medication and lifestyle modification.

How the Renal Denervation Procedure Works

RDN is considered a minimally invasive procedure. It requires an incision in the groin to reach the femoral artery. A specialist inserts a catheter into the artery, guides it to the renal nerves, applies pulses of energy to destroy the nerve endings (a process called ablation), and then removes the catheter and the energy source. 

The specialist performing the procedure may be an interventional radiologist, interventional cardiologist, or vascular surgeon. Renal denervation typically takes about one to two hours. It's usually an outpatient procedure, and patients can go home after a few hours of monitoring.

There are two main ways to deliver the energy: radiofrequency in the Symplicity Spyral system and ultrasound in the Paradise system. Destroying certain renal nerve endings can reduce the nerve activity, which can lower your blood pressure. 

Although RDN was approved for hypertension in 2023, the technology is not new. The proof of concept was published in 2009, and it has been used in limited ways to treat atrial fibrillation, a type of abnormal heartbeat, and pain from autosomal dominant polycystic kidney disease, a genetic disorder.

Effectiveness: How Much Does RDN Lower Blood Pressure?

In clinical trials, the decrease in blood pressure after renal denervation varies. A 2025 clinical review found that, across trials, between two-thirds and three-quarters of people who had renal denervation had their blood pressure decrease by at least 5 mm Hg in ambulatory systolic blood pressure (SBP). Up to a third of the people studied didn’t have a significant drop in blood pressure. 

Clinical trials have included people with various levels of high blood pressure and on various other treatments. An American Heart Association statement points out that the results of renal denervation have varied, and further research is needed to find out who is most likely to benefit from the procedure.

Research has shown that, on average, RDN lowers blood pressure as much as an effective blood pressure medication does. And the effect appears to last over time, as studies have shown lower blood pressure three years and seven years after the procedure.

For example, two clinical trials of RDN devices compared them with a sham control, which is an inactive procedure designed to mimic the actual procedure, and found that their effectiveness lasted. The SPYRAL HTN-ON MED trial (Simplicity) and RADIANCE-HTN TRIO trial (ultrasound RDN) found that they reduced blood pressure that was sustained for up to three years.

Risks and Side Effects of Renal Denervation

Though it’s not surgery, RDN does have risks. Here are some of the potential risks and side effects of renal denervation: 

• Pain where the catheter is inserted
• Bleeding
• Bruising
• Damage to blood vessels
• dislodging cholesterol plaque, which can block blood flow
• Complications involving the contrast agent used in the procedure
• Nausea and vomiting

The American American College of Cardiology/American Heart Association guideline says that all people being considered for renal denervation should be evaluated by a team that has expertise in resistant hypertension and RDN.

Cost and Insurance Coverage for RDN

One drawback of renal denervation is that it’s expensive if your insurance doesn’t cover it.

In October 2025, the Centers for Medicare & Medicaid Services (CMS) announced it would cover renal denervation for uncontrolled hypertension. It covers both the Paradise and Symplicity Spyral systems. 

The CMS decision specifies that the patient must have uncontrolled hypertension and, if they have secondary hypertension, it must be evaluated and treated first. It says patients must be screened for primary aldosteronism, obstructive sleep apnea, and drug- or alcohol-induced hypertension before having RDN.

Clinical Debate: Does RDN Work for Everyone?

In the clinical trials, renal denervation hasn’t worked for everyone.

RDN is a relatively new treatment for high blood pressure, “and some clinicians are inherently conservative in their approaches to new therapies,” says Fisher.

Many of those doctors recall earlier trials that had well-documented shortcomings in study design, as well as a 2014 trial in which RDN did not perform well and “temporarily fell from grace,” she says. But more recent rigorous, randomized, controlled trials show it to be safe and effective, especially in those with the highest baseline blood pressure.

“In other words, the higher the BP before [the] procedure, the greater the expected fall afterwards,” she says. So RDN is more likely to make a significant difference if you have especially high blood pressure. 

Andrew Foy, MD, a cardiologist and associate professor of medicine and public health sciences at Penn State College of Medicine, has doubts about the procedure. “One challenge with the technology is, when it was being developed, the notion was that we would be using it for patients with resistant hypertension,” he says. “It’s arguable how many are resistant.”

False diagnoses may stem from a combination of inaccurate measurements, inadequate medication, a refusal to take meds, or “white coat" syndrome.

Renal Denervation vs. Blood Pressure Medications

Typically, renal denervation is used along with blood pressure medications, not instead of them. The procedure isn’t meant to replace medications.

RDN and blood pressure medications work in different ways. And, while the effectiveness of medications depends on taking them correctly, renal denervation is a single outpatient procedure. So, if you struggle to stick to your blood pressure medication plan, and that limits how well they work, RDN wouldn’t present the same problem of sticking to treatment.

Although renal denervation can help lower blood pressure, it isn’t widely used. This may change as more research progresses.

Takeaways

Renal denervation is another treatment option to lower blood pressure, along with medications and lifestyle changes, when those other options haven’t lowered your blood pressure enough. RDN is an outpatient procedure that uses a catheter to deliver energy to certain nerves, which helps lower blood pressure. Two RDN devices have been approved by the FDA to treat uncontrolled hypertension, and research on other types of devices is ongoing. Renal denervation isn’t right for everyone with hypertension – it’s best for people with uncontrolled hypertension.