Selective vs. Global Renal Denervation: a Case for Less Is More

  • Marat Fudim
  • Asher A. Sobotka
  • Yue-Hui Yin
  • Joanne W. Wang
  • Howard Levin
  • Murray Esler
  • Jie Wang
  • Paul A. Sobotka
Blood Pressure Monitoring and Management (J Cockcroft, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Blood Pressure Monitoring and Management


Purpose of Review

Review the renal nerve anatomy and physiology basics and explore the concept of global vs. selective renal denervation (RDN) to uncover some of the fundamental limitations of non-targeted renal nerve ablation and the potential superiority of selective RDN.

Recent Findings

Recent trials testing the efficacy of RDN showed mixed results. Initial investigations targeted global RDN as a therapeutic goal. The repeat observation of heterogeneous response to RDN including non-responders with lack of a BP reduction, or even more unsettling, BP elevations after RDN has raised concern for the detrimental effects of unselective global RDN. Subsequent studies have suggested the presence of a heterogeneous fiber population and the potential utility of renal nerve stimulation to identify sympatho-stimulatory fibers or “hot spots.”


The recognition that RDN can produce heterogeneous afferent sympathetic effects both change therapeutic goals and revitalize the potential of therapeutic RDN to provide significant clinical benefits. Renal nerve stimulation has emerged as potential tool to identify sympatho-stimulatory fibers, avoid sympatho-inhibitory fibers, and thus guide selective RDN.


Hypertension Renal nerves Nerve stimulation Renal denervation Hot spots 


Compliance with Ethical Standards

Conflict of Interest

Dr. Fudim is supported by an American Heart Association Grant, 17MCPRP33460225 and NIH T32 grant 5T32HL007101; he consults for Coridea, AxonTherapies, and Galvani. Dr. Sobotka is an employee of ROX Medical, Inc.; is consulting for SyMap. Dr. Yin is a consultant for SyMap. Dr. J. Wang is a co-founder of SyMap Medical Ltd. Dr. Esler is supported by a Senior Principal Research Fellowship of the National Health and Medical Research Council of Australia. The other authors declare no conflict of interest relevant to this manuscript. Paul Sobotka

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Marat Fudim
    • 1
    • 2
  • Asher A. Sobotka
    • 3
  • Yue-Hui Yin
    • 4
  • Joanne W. Wang
    • 5
  • Howard Levin
    • 6
  • Murray Esler
    • 7
  • Jie Wang
    • 8
    • 9
  • Paul A. Sobotka
    • 10
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.Duke Clinical Research InstituteDurhamUSA
  3. 3.St. Paul Academy and Summit SchoolSt. PaulUSA
  4. 4.The 2nd Affiliated Hospital of Chongqing Medical UniversityChongqinChina
  5. 5.Horace MannBronxUSA
  6. 6.CorideaNew YorkUSA
  7. 7.Baker Heart and Diabetes InstituteMelbourneAustralia
  8. 8.Columbia UniversityNew YorkUSA
  9. 9.SyMap Medical Ltd.SuzhouChina
  10. 10.Rox Medical, Inc.San ClementeUSA

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