Renal Denervation’s Clinical Pathway: Who’s Involved?

RDN requires a multidisciplinary approach that involves clinicians with various specialties

Dr Chang-Wook Jeong, co-founder and Chief Medical Officer of DeepQure

Renal denervation (RDN) is rapidly emerging as a promising adjunct to antihypertensive medications, and may one day replace them entirely for some patients. But RDN isn’t a plug-and-play substitute for drug therapy – unlike pharmacologic interventions, its procedural approach means that renal denervation's clinical pathway is a different one involving specialists.

Dr Chang-Wook Jeong, co-founder and Chief Medical Officer of DeepQure, is the inventor of the company’s HyperQure system, which uses a novel laparoscopic approach to perform extravascular RDN. Through the development of HyperQure and its ongoing clinical trials, he has gained unique insights into RDN’s development – both as a procedure and, on a broader level, as a permanent treatment for hypertension.

Dr Jeong shares his perspectives on various RDN-related issues and considerations below.

Primary care physicians are usually the first point of contact for patients with hypertension, as they provide the initial diagnosis, patient education, and treatment. Beyond general practitioners, are specialists also involved?

In the context of renal denervation (RDN), yes. Generally speaking, cardiologists and nephrologists are considered specialists in hypertension management. However, there are various subspecialties within these departments. Therefore, cardiologists and nephrologists who primarily manage patients with hypertension are the most appropriate individuals to consult from RDN's perspective.

How will these different clinicians work together to assess, recommend, and provide renal denervation?

Close collaboration across specialties is common, with typical examples including cardiac surgery, which involves both cardiology and thoracic surgery, as well as gastrointestinal surgery, which involves gastroenterology and general surgery.

Similarly, RDN can be considered a type of collaborative approach between nephrologists (or cardiologists) and urologists who manage kidney-related diseases. When a patient does not respond adequately to existing treatment or requires a surgical approach from another department, the internist refers the patient to the appropriate surgical department. That's when the process to explore RDN as an intervention begins for the patient.

While primary care physicians are the first point of contact for hypertensive patients, internists will make referrals to the appropriate departments should RDN be considered as an option

Are there any gaps in knowledge, clinical guidelines, policies, etc, in how RDN is used for hypertension treatment, especially for patients with resistant/refractory hypertension?

The RDN technique was approved by the FDA in 2024. In parallel, both European and US guidelines recommend RDN as a treatment option for resistant or refractory hypertension. On that front, I think progress is coming along nicely. I do see room for RDN’s usage to expand though. In the near future, as evidence continues to accumulate in real-world clinical practice, hypertensive patients who are on just one or two antihypertensive medications and wish to discontinue them may also become good candidates for RDN.

Much of the discussion around RDN currently centres on issues of suitability, efficacy, and risks. These are precisely the hurdles that DeepQure’s HyperQure system is working to address with its extravascular approach. What other challenges are there once these have been overcome?

Recent long-term follow-up data over three years after catheter-based RDN treatment has demonstrated sustained blood pressure-lowering effects. If catheter-based RDN, despite its limitations – such as the risk of endothelial damage, restricted energy delivery due to safety concerns, and technical challenges in treating small vessels (e.g. accessory or early-branching arteries) – can achieve these durable results, then extravascular RDN has the potential to demonstrate at least comparable, if not superior, efficacy once ongoing research is completed. That is a hurdle that will be crossed with enough time.

What do you think is needed to establish RDN as a standard of care and, beyond that, make it a primary intervention for hypertension?

First, RDN should demonstrate superior blood pressure-lowering efficacy compared to pharmacologic therapy, and offer patients a greater chance of discontinuing all antihypertensive medications. Extravascular RDN, which addresses the limitations of the catheter-based approach described above, has the potential to provide this opportunity.

Second, hypertension should be recognized as a condition that can be treated not just pharmacologically, but also through procedural or surgical interventions – similar to cardiac or gastrointestinal diseases discussed earlier. Therefore, closer collaboration between medical internists and urologists should become more common in clinical practice. In addition, a shift in patient perception and awareness toward this treatment paradigm is also necessary.

Finally, guideline developers and policymakers should take note of these changes and reflect them in future clinical guidelines and governmental insurance policies as evidence continues to accumulate.

When these three criteria are met, we should see RDN become a standard of care and possibly a primary intervention for hypertension.