The treatment of refractory hypertension by transcatheter renal sympathetic denervation (RDN) is limited to the following four conditions: 1. Adequate and reasonable application of 3 or more antihypertensive drugs with different mechanisms of action, including diuretics (aldosterone antagonists when not clinically contraindicated), with an office systolic blood pressure ≥ 160 mmHg after several months of treatment. The diagnosis of hypertension was also determined by 24-h ambulatory blood pressure monitoring or home self-measurement of blood pressure to exclude white coat hypertension. 2. The diagnosis of refractory hypertension was determined by a tertiary or hypertension-specialized hospital and a qualified hypertension specialist. 3. and clinical examination, evaluate the structure and function of the heart, kidney and blood vessels, and fully exclude secondary hypertension, pseudo-refractory hypertension (blood pressure measurement factors, poor compliance of patients with medication, taking antihypertensive drugs, etc.).4. Renal glomerular filtration rate eGFR ≥ 45 ml/(min・1.73m2), computed tomography angiography (CTA) or magnetic resonance angiography ( RDN may also be considered if necessary after detailed evaluation and specialist consultation in the following two cases: 1. The patient has a true intolerance to certain antihypertensive drugs, and the hypertension specialist determines that this intolerance is not due to the patient’s own neurological or psychiatric factors or poor physician-patient communication. 2. Combined reversible risk factors for hypertension, such as obesity, excessive alcohol consumption, sleep apnea, high sodium intake, etc., should be changed before these controllable risk factors. Those whose blood pressure still cannot reach the standard after controlling these factors, or those who cannot control these factors. Contraindications to transcatheter renal sympathetic denervation (RDN) for refractory hypertension (intractable hypertension): 1) evidence of renal artery stenosis (>50% stenosis); 2) previous renal artery intervention; 3) renal glomerular filtration rate eGFR <45 ml/(min・1.73m2 ); 4, multiple renal arteries or renal artery trunk diameter <4 mm or length <20 mm, etc.
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