A 55-year-old white man with resistant hypertension (HTN) and hyperlipidemia presents for routine follow-up. His current medications include olmesartan 40 mg daily, chlorthalidone 25 mg daily, spironolactone 50 mg daily, amlodipine 10 mg daily, and atorvastatin 80 mg at bedtime.
His vital signs include heart rate 67 bpm, respiratory rate 18 breaths/min, and blood pressure (BP) 150/80 mm Hg. His weight is 75 kg (165 lbs) and height is 173 cm (5' 8"). Evaluation for secondary causes of resistant HTN reveals obstructive sleep apnea, which is currently being managed with continuous positive airway pressure (CPAP).
He is referred to an HTN center to consider renal denervation (RDN) for treatment of his uncontrolled HTN.
The correct answer is: B. Renal artery stenosis.
Renal artery disease, such as significant stenosis, aneurysm, or a pre-existing renal artery stent, is a contraindication for RDN.
Obstructive sleep apnea is a common secondary contributor to HTN rather than an exclusion criterion, and patients successfully managed with CPAP remain eligible. Although patients with peripheral vascular disease require careful assessment of their femoral access site, it is not an absolute contraindication unless their vascular anatomy impedes safe catheter deployment. Finally, patients with uncontrolled HTN are primary candidates for this procedure.
This patient case quiz is part of the larger Overcoming Challenges in Hypertension Management initiative, supported by AstraZeneca. To visit the Overcoming Challenges in Hypertension Management grant page and access educational activities on this topic, click here.
References
- Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2025;86(18):1567-1678. doi:10.1016/j.jacc.2025.05.007
