Renal Denervation in Asia: 2025 Asia Renal Denervation Consortium (ARDeC) Consensus Statement Endorsed by the Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network

Abstract

The second Asia Renal Denervation Consortium consensus conference shared information and developed updated recommendations for renal denervation (RDN). Current evidence confirms that RDN significantly reduces blood pressure across all metrics (office, home, and ambulatory) throughout 24 hours. Modern RDN approaches target the distal main renal artery and branches where nerves more closely approximate the vessel wall. Understanding renal artery anatomy is crucial; the main renal artery typically divides into anterior and posterior divisions as first-order branches, which further subdivide into second-order segmental arterial branches. Renal artery electrical stimulation shows promise as a procedural end point, with blood pressure response attenuation after successful RDN suggesting adequate denervation, though the optimal procedural end point remains to be established. The indication for RDN is resistant or uncontrolled hypertension, with high office, home, or 24-hour ambulatory blood pressure readings despite appropriate lifestyle modification and antihypertensive drug therapy. Preprocedure assessment includes comprehensive screening for secondary causes and detailed renal artery imaging. Checklists for preprocedure and postprocedure assessment are provided. Nocturnal hypertension and morning hypertension, which are common in Asia, are more closely associated with cardiovascular risk than daytime hypertension and are more difficult to control with current guideline-driven medication. Based on these Asian characteristics and RDN's long-term durability, RDN should be considered an effective option for facilitating optimal 24-hour blood pressure control. Future research through real-world data collection will help determine ethnic differences in RDN response between Asians and Westerners and identify optimal candidates. In addition, studies are needed to evaluate RDN's ability to prevent organ damage and cardiovascular events.