==== Front Egypt Heart J Egypt Heart J The Egyptian Heart Journal 1110-2608 2090-911X Springer Berlin Heidelberg Berlin/Heidelberg 37394542 387 10.1186/s43044-023-00387-w Commentary Ultrasound renal denervation: the future of hypertension management? Ali Laiba Laiba.aliqazi@gmail.com Fatima Hareer hareer333@gmail.com Riaz Faiza faizariaz0612@gmail.com Mustafa Muhammad Saqlain msaqlain.mustafa@gmail.com Rangwala Burhanuddin Sohail brangwala70@gmail.com http://orcid.org/0009-0007-2167-3481 Rangwala Hussain Sohail srangwala01@gmail.com grid.415944.9 0000 0004 0606 9084 Department of Medicine, Jinnah Sindh Medical University, Iqbal Shaheed Rd, Karachi, Pakistan 3 7 2023 3 7 2023 12 2023 75 5521 4 2023 29 6 2023 © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Background Hypertension, a leading cause of global mortality and morbidity, affects approximately 1.28 billion adults worldwide, with most cases occurring in low- and middle-income countries. Despite several methods for managing mild to moderate hypertension, effective management of severe or resistant hypertension remains challenging. Renal denervation, a promising non-pharmacological technique, has emerged as a potential solution. Main body Renal denervation works by modifying the renal sympathetic nerve supply through techniques such as ultrasound, radiofrequency energy, or injection of neurolytic agents, reducing blood pressure. Clinical trials, including the RADIANCE series, have shown consistent effectiveness of ultrasound renal denervation in lowering blood pressure, especially in patients who were previously unresponsive to anti-hypertensive medications. After a follow-up of 2 months, mean ambulatory systolic blood pressure during the daytime decreased significantly in the ultrasound renal denervation group compared to the sham group. However, further research is needed to determine renal denervation's long-term safety and efficacy. Conclusions In conclusion, renal denervation holds great potential in improving the treatment of uncontrolled or resistant hypertension treatment, but more investigations and trials are necessary to establish its effectiveness and safety. Keywords Hypertension Renal denervation Radiofrequency energy issue-copyright-statement© Egyptian Society of Cardiology 2023 ==== Body pmcBackground Hypertension is a leading cause of both mortality and morbidity globally. It is estimated that 1.28 billion adults between the ages of 30–79 years suffer from hypertension worldwide, with the majority of cases (two-thirds) occurring in low- and middle-income countries. Approximately half (46%) of adults with hypertension are unaware of their condition. While several methods are available for managing mild to moderate hypertension, effective management of severe or resistant hypertension remains a challenge. A promising new non-pharmacological technique called Renal Denervation has emerged to address this issue. The Renal Denervation technique modifies the renal sympathetic nerve supply and introduces heat energy to the sympathetic nerves surrounding the kidneys. This results in a reduction in blood pressure. This technique can be used with anti-hypertensive drugs or as a standalone treatment. [1, 2]. Main body The renal denervation technique consists of three different methods by which it can be carried out. These include using ultrasound, radiofrequency energy, and injecting neurolytic agents into the vascular tissues surrounding the kidneys. This technique is still relatively new, and more investigations and trials must be done [3]. The effectiveness of Ultrasound Renal Denervation has been investigated in the guise of 3 separate multicenter, international, blinded, randomized, sham-controlled trials, that are as follows: 1. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO) [4]; 2. Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO) [5], and 3—endovascular Ultrasound Renal Denervation to Treat Hypertension: The (RADIANCE II) Randomized Clinical Trial [6]. In the first trial, the target population had patients who were previously consuming anti-hypertensive drugs but were not consuming them. In the second trial, the target population was patients who were resistant to more than three anti-hypertensive drugs even after shifting to a single pill made of a combination of three anti-hypertensive drugs. The third trial in the RADIANCE series was done on patients who had high blood pressure despite taking up to two anti-hypertensive drugs; this trial aimed to assess the effectiveness of Ultrasound Renal Denervation without the influence of anti-hypertensive drugs. These trials, especially the RADIANCE-HTN TRIO trial, explicitly tell us how patients with no change with various anti-hypertension medications can decrease their blood pressure after undergoing Ultrasound Renal Denervation. Thus, in itself, it proves this technique's importance in treating resistant or uncontrolled hypertension. All three studies of the before-mentioned clinical trials involved patients aged 18 to 75 years. In total, 506 patients were investigated in the three studies. Ajay and his colleagues have pooled the data from these three clinical trials [7]. In light of the pooled data, it can be said that Ultrasound Renal Denervation consistently lowered blood pressure regardless of the severity of HTN in sham-controlled trials created with a goal of a 2-month end period to measure medication across groups that were randomly generated uniformly. After a follow-up of 2 months, mean ambulatory systolic Blood pressure during daytime decreased by 8.5 mm Hg from the pre-randomization baseline to 141.8 (13.8) mm Hg after an Ultrasound Renal Denervation vs. a drop in blood pressure to 147.9 (14.6) mm Hg after sham which is a decrease of only 2.9 mm Hg [7]. Hence this significantly proves the effectiveness of Ultrasound Renal Denervation techniques and their future potential in treating uncontrolled or resistant hypertension. Conclusions In conclusion, hypertension is a significant global health concern, with many cases going undiagnosed. Renal denervation, a non-pharmacological technique that modifies the renal sympathetic nerve supply, has emerged as a promising solution for managing severe or resistant hypertension and has shown consistent effectiveness in decreasing blood pressure in randomized clinical trials. Although further research is required to determine its long-term safety and efficacy, ultrasound renal denervation holds great potential in improving the treatment of hypertension. Abbreviations RADIANCE-HTN SOLO Endovascular ultrasound renal denervation to treat hypertension RADIANCE- HTN TRIO Ultrasound renal denervation for hypertension resistant to a triple medication pill RADIANCE II Endovascular Ultrasound Renal Denervation to Treat hypertension Acknowledgements None. Author contributions HSR and HF did the conceptualization. FR, MSM, HF, LA, and BSR conducted the literature and drafting of the manuscript. HSR performed the editing and supervision. All authors have read and agreed to the final version of the manuscript. Funding The authors received no extramural funding for the study. Availability of data and materials Not applicable. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no potential conflicts of interest concerning this article's research, authorship, and publication. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. ==== Refs References 1. Hypertension. [Internet] https://www.who.int/news-room/fact-sheets/detail/hypertension 2. Heradien MJ van der Bijl P Brink PA Renal denervation in high-risk patients with hypertension Heart Int 2019 13 2 12 16 10.17925/HI.2019.13.2.12 36274824 3. Rey-García J Townsend RR Renal denervation: a review Am J Kidney Dis 2022 80 4 527 535 10.1053/j.ajkd.2022.03.015 35598810 4. Azizi M Schmieder RE Mahfoud F Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomized, sham-controlled trial Lancet 2018 391 10137 2335 2345 10.1016/S0140-6736(18)31082-1 29803590 5. 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