Selecting patients for interventional procedures to treat hypertension.

RDN has emerged as a safe and effective approach to treat hypertension with BP lowering efficacy equivalent to antihypertensive monotherapy albeit with guaranteed 'adherence'Presently populations most likely to respond to RDN are not clearly defined but given the costs of the procedure it is likely to be initially made available to those with resistant hypertension and those at highest cardiovascular riskThere is no evidence to support the use of RDN in patients with secondary forms of hypertension and thus this should be thoroughly screened for prior to offering the procedure, especially in the setting of resistant hypertensionOptimisation of lifestyle and drug therapy is key to good hypertension management and should be undertaken prior to an invasive procedure such as RDN being offeredThere are numerous pitfalls in the screening process for secondary hypertension which means that hypertension specialists should be involved in this component of the pathwayRDN can be offered by interventional radiologist, interventional cardiologists or angiologists who have had appropriate trainingClinical pathways for RDN must ultimately involve a multidisciplinary team overview with hypertension specialists, interventionists and imaging specialists combining efforts to ensure appropriate patient selection. This without question must involve patients in the decision-making process.