Authors' objectives: This health technology assessment evaluates the effectiveness, safety, and cost-effectiveness of renal denervation as an adjunctive treatment to standard care in adults with uncontrolled hypertension. It also evaluates the budget impact of publicly funding renal denervation for uncontrolled hypertension and the experiences, preferences, and values of adults with uncontrolled hypertension.

Authors' results and conclusions: Results We included 10 systematic reviews of randomized controlled trials in our clinical evidence review, all of which showed that renal denervation statistically significantly lowered systolic blood pressure more than standard care (by a mean of 2.1-6.3 mmHg), regardless of the type of renal denervation system used, the blood pressure end points assessed, and whether people were taking antihypertensive medications at the time of the procedure. Renal denervation in addition to standard care is more effective and more expensive than standard care alone. The incremental cost-effectiveness ratio of renal denervation in addition to standard care compared with standard care alone is $121,237 per quality-adjusted life-year (QALY) gained over a lifetime horizon. The probability of renal denervation in addition to standard care being cost-effective versus standard care alone is 0% at a willingness-to-pay (WTP) of $50,000 per QALY gained, 18.02% at a WTP of $100,000 per QALY gained, and 80.50% at a WTP of $150,000 per QALY gained. The cost-effectiveness results were sensitive to changes in time horizon, assumptions about the duration of treatment effect, and the cost of the renal denervation procedure (including the cost of the renal denervation system). The annual budget impact of publicly funding renal denervation for adults with uncontrolled hypertension in Ontario over the next 5 years ranges from an additional $0.42 million in year 1 to an additional $3.78 million in year 5. Our review of the quantitative evidence of patient and provider preferences and values found that about 30% of patients preferred renal denervation over drug therapy, with younger individuals and those with poor medication adherence more likely to favour it. All interview participants expressed a positive view of renal denervation. Those we spoke with who had undergone the procedure reported lower blood pressure, fewer doctor's visits, and greater peace of mind compared with those who had not, and some reported a reduction in medication. Others reported being open to renal denervation if it were recommended by their physician after other treatments had failed. Barriers to accessing renal denervation included limited awareness of the procedure and limited geographic access. Conclusions In our overview of reviews, we found that renal denervation consistently lowers blood pressure more than standard care in adults with uncontrolled hypertension, including treatment-resistant hypertension. No statistically significant differences in safety outcomes or adverse events between groups were reported in the included reviews. Renal denervation in addition to standard care is more effective and more expensive than standard care alone. We estimate that publicly funding renal denervation for adults with uncontrolled hypertension in Ontario would result in additional annual costs of between $0.42 million and $3.78 million over the next 5 years. Our review of the quantitative evidence of patient and provider preferences and values and our direct patient engagement findings highlight renal denervation as a potential treatment option for adults with uncontrolled hypertension. Renal denervation was viewed favourably by all those we interviewed, particularly when other treatments have failed.

Authors' recommendations: Ontario Health, based on guidance from the Ontario Health Technology Advisory Committee, recommends publicly funding renal denervation as an adjunctive treatment to standard care for selected adults with uncontrolled hypertension.

Project Status: Completed

URL for protocol: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025641644

Year Published: 2026

URL for published report: https://pmc.ncbi.nlm.nih.gov/articles/PMC12929946/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Ontario

Pubmed ID: 41743168

Organisation Name: Ontario Health

Contact Address: 525 University Ave, Toronto, ON M5G 2L3

Contact Name: HealthInnovationPathway@ontariohealth.ca

Contact Email: HealthInnovationPathway@ontariohealth.ca

Copyright: The copyright for all Ontario Health publications is owned by the King’s Printer for Ontario. Materials may be reproduced for commercial purposes only under a licence from the King’s Printer. For further information or to request a licence to reproduce content, please contact: Senior Copyright Advisor Publications Ontario | 416-326-5153 | Copyright@Ontario.ca