Renal Denervation

Renal denervation (RDN) is a minimally invasive procedure designed to help lower high blood pressure (hypertension) in selected patients. It works by reducing overactive nerve signals around the kidney arteries (renal arteries) that can contribute to persistently raised blood pressure.

Renal denervation is not a replacement for lifestyle changes or medication for everyone. It is typically considered when blood pressure remains high despite treatment, when medication side effects limit treatment, or in carefully selected cases following specialist assessment.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and advice on whether renal denervation may be appropriate, and we coordinate onward specialist pathways where needed.

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What renal denervation is used for

Renal denervation is primarily used as a treatment option for:

• Uncontrolled hypertension (blood pressure remains high despite appropriate treatment)
• Resistant hypertension (blood pressure remains high despite multiple medications, typically including a diuretic)
• Patients who struggle with tolerating medication or maintaining consistent medication due to side effects, after careful review

The goal is to reduce long-term cardiovascular risk by lowering blood pressure in appropriate patients.

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How renal denervation works

The kidneys have nerves around the renal arteries that influence:

• blood vessel tone
• salt and water balance
• hormones involved in blood pressure regulation

In some people, these nerves are overactive. Renal denervation uses a catheter to deliver energy (commonly radiofrequency or ultrasound, depending on the system) to disrupt these nerves. This can reduce nerve signalling and help lower blood pressure over time.

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Who may be suitable

Suitability depends on your overall health, blood pressure pattern, and renal artery anatomy. Renal denervation is usually considered after a structured hypertension review, which may include:

• Confirming hypertension with home or 24-hour ambulatory monitoring
• Reviewing medication type, dose and adherence (and side effects)
• Screening for secondary causes of hypertension (e.g., kidney disease, hormonal causes, sleep apnoea)
• Assessing kidney function and cardiovascular risk
• Imaging of the renal arteries where appropriate

Renal denervation is not suitable for everyone, and a specialist will advise based on your individual findings.

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Symptoms that may prompt assessment

High blood pressure often has no symptoms, even when readings are very high. Some people seek assessment due to:

• repeated high readings at home or in clinic
• headaches, dizziness, or blurred vision (not reliable indicators on their own)
• a history of complications (e.g., stroke, heart disease)
• difficulty controlling blood pressure despite treatment

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Diagnosis and assessment at Royal Buckinghamshire Hospital

Your assessment may include:

• Full symptom and medical history review
• Blood pressure measurement and review of home readings
• Blood tests (kidney function, electrolytes, glucose, cholesterol)
• Urine testing where appropriate
• ECG and cardiovascular assessment where indicated
• Review of current medications and side effects
• Discussion of next-step options, including whether renal denervation is worth exploring

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What happens during the procedure

Renal denervation is typically performed in a catheter laboratory setting. While pathways vary by provider, it generally involves:

• Local anaesthetic at the groin or wrist access site (sometimes with light sedation)
• A thin catheter passed into the renal arteries under imaging guidance
• Delivery of treatment energy to targeted areas of the artery to disrupt the surrounding nerves
• Monitoring afterwards, with discharge planning depending on your case

Your clinician will explain preparation instructions, expected duration, and what to bring/arrange for the day.

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Benefits of renal denervation

Potential benefits may include:

• Lower blood pressure in selected patients
• Reduced reliance on, or lower doses of, medication for some people (not guaranteed)
• A longer-term “always on” effect that does not depend on taking tablets every day

It’s important to note:

• Response varies between individuals
• Blood pressure reduction may be gradual over weeks to months
• Many patients still need blood pressure medication, but potentially with improved control

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Risks and complications

Renal denervation is generally considered low risk, but complications can occur. These may include:

• Bleeding, bruising, or infection at the catheter entry site
• Damage to the artery (rare but serious)
• Kidney artery narrowing or injury (uncommon)
• Temporary changes in kidney function (monitoring is part of care)
• Contrast reaction (if contrast dye is used)
• Failure to achieve meaningful blood pressure reduction in some patients

Your consultant will discuss risks in the context of your health, anatomy, and alternatives.

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Recovery and aftercare

After the procedure, you may be advised to:

• rest for a short period and avoid heavy lifting for a few days
• continue blood pressure monitoring at home
• keep taking prescribed medication unless your clinician changes it
• attend follow-up to review blood pressure response and adjust medication if needed

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Alternatives to renal denervation

Depending on your situation, alternatives may include:

• Optimising medication type and dose (including addressing side effects)
• Lifestyle measures (weight, salt intake, alcohol, exercise, sleep)
• Treating any secondary cause of hypertension (e.g., sleep apnoea)
• Specialist hypertension clinic review

Renal denervation is typically considered as part of a broader hypertension management plan, not in isolation.

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When to seek urgent help

Seek urgent medical advice immediately if you develop:

• chest pain, severe breathlessness, collapse, or signs of stroke
• very high blood pressure readings with severe symptoms (such as severe headache with neurological symptoms)
• after a procedure: significant bleeding from the access site, a rapidly enlarging painful swelling, or a cold/pale/numb limb

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If you have uncontrolled high blood pressure and want to understand whether renal denervation could be suitable for you, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.