Renal denervation for hypertension management in the UK: a Delphi expert consensus.

BACKGROUND: Renal denervation (RDN) has emerged as a guideline-recommended therapeutic option in hypertension management with several high-quality, randomised, placebo-controlled trials demonstrating efficacy and safety. However, the lack of expert consensus on patient selection for RDN in the UK has led to debate regarding its use. This study aimed to establish a multidisciplinary consensus to provide clinicians and commissioners with guidance on the appropriate use of RDN in hypertension management within the UK. METHODS: The project used a modified Delphi method. A steering group (SG) of seven clinicians in cardiology, clinical pharmacology, radiology, nephrology and general practice, all experienced in managing patients with hypertension, convened in June 2024. The SG aligned on 40 consensus statements covering key topics (patient identification and selection, multidisciplinary team collaboration, commissioning and guidelines, training and education and awareness of RDN). The statements were distributed as an online survey to UK clinicians involved in hypertension management. Respondents assessed their level of agreement using a four-point Likert scale. Consensus was predefined as 75% agreement. The surveys were collated anonymously and independently analysed. The results were shared with the SG in November and December 2024. RESULTS: A total of 125 responses were received from interventional cardiologists and radiologists, cardiologists, clinical pharmacologists and nephrologists across various regions of the UK.Consensus was achieved for 37 out of 40 statements (93%). Based on the consensus scores, 11 key recommendations were developed by the SG regarding patient selection, multidisciplinary collaboration, clinician training and commissioning for RDN. CONCLUSIONS: This expert consensus defines patient selection criteria for RDN and provides 11 recommendations to support its use. RDN should be considered for resistant hypertension or intolerance to medications, using a multidisciplinary approach. Implementation of these recommendations could guide clinical practice, inform commissioning and support National Institute for Health and Care Excellence reviews, ultimately improving patient access across the UK.