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Catheter-based renal sympathetic denervation (RDN) has opened the new world in the treatment of resistant or refractory hypertension. However, SYMPLICITY HTN-3, 2:1 randomization, blinded and sham-controlled study did not show a significant reduction of systolic blood pressure (BP) in patients with resistant hypertension 6 months after RDN as compared with a sham control. After that, substudy investigating the predictors of BP responses in SYMPLICITY HTN-3 trial was reported; racial difference and optimal medical treatment were issued for the optimal denervation therapy. Recent data (GSR Korea data) showed RDN provided a significant reduction in 6- and 12-month office SBP among Asian patients, with a favorable safety profile. The 12-month systolic BP reduction was larger than that observed in Caucasian patients, suggesting there could be ethnic difference in the effects of RDN for resistant hypertension. The optimal medical therapy is still mainstay in the treatment of resistant hypertension. OSLO RDN trial suggest that adjusted drug treatment has superior BP lowering effects compared with RDN in patients with true resistant hypertension. In DENERHTN (Renal Denervation for Hypertension) trial demonstrated that RDN plus standardized stepped-care antihypertensive treatment decreased ambulatory BP more than the same medication alone at 6 months. For the successful RDN therapy causing BP decrease, the effective perfect denervation by complete catheter contact would be still most important. Related with this, we should pay attention to the upcoming new-generation multi-electrode system, one shot system. In conclusion, RDN therapy is not the end. However, we need a more concrete data and should await future studies.

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