Concierge hypertension medicine · UK
Renal denervation - what it is, whether it is for you, and how to decide.
A plain-English patient guide to renal denervation for treatment-resistant hypertension - the evidence, what NICE says, how it fits with medication, and how to decide whether the procedure earns its place in your care.
Why patients choose us
- 01
A hypertension specialist first, not a proceduralist
Your first conversation is with a hypertension consultant - not the interventionalist paid to do the procedure. That order matters.
- 02
The evidence, honestly summarised
Sham-controlled trials, real-world registries and the durability data - laid out plainly so you can weigh the decision, not sold.
- 03
Every non-procedural option first
Adherence support, drug rationalisation, salt and sleep. If any of these has been skipped, we start there.
Indicative pricing
What the private renal denervation pathway costs in the UK.
Indicative ranges for the decision review, workup and - if you choose it - the procedure itself.
In short
Hypertension consultation and shared decision: £300–£500, procedure quoted separately.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Hypertension consultation and shared decision review | £300–£500 | 45–60 min | Same visit |
| Full workup: ambulatory BP + secondary-cause screen | £1,200–£2,200 | 1–2 weeks | Outpatient |
| Adherence testing (drug-level assays where available) | £350–£600 | 1 visit | 7–10 days |
| Renal denervation procedure (see sister page) | £16,000–£26,000 | 60–90 min | Day-case or 1 night |
| 12-month structured hypertension follow-up | £950–£1,600 | 4 visits | Ongoing |
| Second-opinion review of an outside RDN recommendation | £400–£650 | 45–60 min | Same visit |
| Home BP monitor and diary starter pack | £65–£140 | - | Posted |
Prices vary by hospital and by whether the pathway includes only the consultation, the full workup, the procedure or all three. Firm quotes are back within one working day, with cover checked.
The problem
The right question is not just how, but whether.
Most patients sent to a renal denervation clinic already have unaddressed adherence, secondary causes or under-used spironolactone. A proper decision review - not a procedure booking - is the honest starting point.
Confirm resistance is real
Ambulatory BP, adherence testing and screening for secondary causes come before any discussion of the cath lab.
Try the fourth drug
Spironolactone often beats RDN in resistant hypertension - and costs pennies. Anyone skipping it is skipping the evidence.
Weigh the numbers honestly
6–10 mmHg office SBP average, individual variation, no cardiovascular endpoint yet - the shared decision is a real one.
The journey
From first review to shared decision - what happens, in order.
One hypertension consultant sees you from workup through decision and 12-month review - whichever route you choose.
Phase 1 · Before
Consultation, workup, screen
Phase 2 · On the day
Shared decision, procedure or optimisation
Phase 3 · After
Ambulatory BP and reassessment
- 01
Before
You tell us the story so far
How long BP has been raised, tablets tried and stopped, ambulatory data, family history, and how much lifestyle has been addressed.
- 02
Before
We come back with a plan
Within one working day: whether renal denervation is even a reasonable question, what still needs testing, and the sensible next step - often not the procedure.
- 03
Before
Adherence and physiology check
Drug-level testing where available, a fresh ambulatory 24-hour BP, home diary and secondary-cause screen (aldosterone-renin, metanephrines, renal imaging, sleep study).
- 04
Before
Shared decision consultation
A hypertension consultant walks through the evidence: average BP fall, individual variation, medication reduction, durability and residual risks.
- 05
On the day
If you decide yes: the day of the procedure
Day-case interventional cardiology, femoral or radial access, energy delivered to both renal arteries. Detail lives on the sister page - the decision lives here.
- 06
On the day
If you decide no: an optimised medical plan
A quadruple regimen tailored to you, adherence tools, salt and sleep pathway. Reviewed on ambulatory BP at three and six months.
- 07
After
Same follow-up, either route
Ambulatory BP at 3, 6 and 12 months. Cardiovascular risk reviewed against your baseline. Reassessment for RDN if drugs alone cannot get you to target.
Typical end-to-end: 4–6 weeks to reach a shared decision. Full effect is judged at 6 months.
When it helps
When the renal denervation conversation earns its place.
Situations where the discussion is worth having - plus the four common causes of pseudo-resistance we always exclude first.
-
Genuinely resistant hypertension
BP consistently ≥140/90 despite three drugs at maximum tolerated dose including a diuretic, confirmed on ambulatory monitoring - the classic denervation conversation.
-
Side-effect-limited titration
You want lower BP but tolerate fewer tablets. Renal denervation can substitute for one or two agents in many patients.
-
High cardiovascular risk background
Established CVD, diabetes with target-organ damage, or chronic kidney disease - where a modest BP fall matters most.
-
Complicated younger-adult hypertension
An adult in their thirties or forties on multiple drugs who wants to think long-term about drug burden - a legitimate shared-decision moment.
-
Nocturnal, non-dipping BP pattern
A high overnight BP on ambulatory monitoring, resistant to timed medication. Signals stronger sympathetic drive and may predict a better response.
-
Post-menopausal women with drug intolerance
A group over-represented in RDN registries - often intolerant of ACE inhibitors and beta-blockers and looking for a durable option.
-
Ethnic groups with high salt sensitivity
Where diuretics remain central and RDN can complement rather than replace them.
-
Red flag: it is not resistance if it is not addressed
Missed tablets, undiagnosed sleep apnoea, primary aldosteronism, high salt intake - these are the four biggest reasons a case labelled resistant is not actually resistant.
Procedure options
The full menu - before RDN, and around it.
Every treatment option, in order - lifestyle, adherence, drug rationalisation, spironolactone, secondary-cause treatment, radiofrequency RDN, ultrasound RDN, and doing nothing more for now.
-
Lifestyle first, always
Salt to ≤5 g/day, alcohol within UK limits, weight loss, aerobic exercise and - where relevant - smoking cessation. Free, and never replaced by a procedure.
-
Adherence and simplification
Single-pill combinations, once-daily dosing, drug-level testing where available. Undiagnosed non-adherence is the single most common cause of ‘resistance’.
-
Fourth-line spironolactone
The PATHWAY-2 trial showed spironolactone beats other add-ons for resistant hypertension. Anyone considered for RDN should have tried it - or have a proper reason not to.
-
Treating secondary causes
Primary aldosteronism, phaeochromocytoma, renal artery stenosis, Cushing’s and obstructive sleep apnoea each have specific treatments that beat RDN.
-
Renal denervation, radiofrequency
Multi-electrode catheter, radiofrequency energy in a spiral pattern along the main renal artery and its branches. The largest evidence base.
-
Renal denervation, ultrasound
Balloon-mounted ultrasound transducer delivering circumferential energy. Positive sham-controlled trials, particularly in younger patients on fewer drugs.
-
Baroreflex activation and other devices
Investigational alternatives sitting outside routine UK practice. We flag them so you know what has and has not been NICE-approved.
-
Doing nothing more, for now
An entirely valid choice for some patients with stable, well-tolerated, mildly resistant hypertension and low residual risk. We say so when it applies.
Our vetted UK network
A small panel of hypertension specialists, we picked them.
Consultants in London and the major UK cities who work at the front door of RDN centres - but see you first as a patient, not a procedure booking.
Selection criteria
How we choose every hypertension specialist in our network.
-
Hypertension consultants on the GMC specialist register
-
Access to ambulatory BP monitoring, aldosterone-renin, metanephrines and adherence testing
-
Partnership with NICE IPG754-compliant RDN centres for those who choose the procedure
-
Shared-decision approach - never a procedure-only front door
Safety and recovery
How to weigh the decision, honestly.
The safest route is the one that gets you to target with the least fuss - and it is not always the procedure.
The safest option is the one that gets you to target
Renal denervation is not automatically safer than tablets - it is a different balance of risk, benefit and effort. Assessed on your numbers, not general enthusiasm.
BP fall is real but modest
Sham-controlled trials show an average 6–10 mmHg office SBP fall at six months. Some patients respond much more, some barely at all - the average is not a promise.
Procedural risks are small
Access-site bleeding 2–4% (femoral), renal artery injury well under 1%. Detail lives on the RDN procedure page.
Long-term renal function looks stable
Registry and trial data to three years show no meaningful long-term decline in renal function after RDN in properly selected patients.
You will still be on medication
RDN reduces drug burden; it does not replace it. Rationalisation is done by a hypertension consultant using ambulatory data.
Non-responders exist
Around 20–30% of patients show little or no BP fall after RDN. Selection and honest expectation-setting reduce, but do not eliminate, this.
Durability continues to accrue
Three-year data are positive; longer-term evidence continues to build. Anyone claiming a lifetime cure is over-selling.
Cardiovascular endpoint data are still awaited
BP fall is a proven surrogate; hard cardiovascular endpoint trials are underway. Reasonable patients weigh this differently.
Red flag: hypertensive emergency
BP ≥180/120 with headache, visual change, chest pain, breathlessness or acute kidney injury is A&E the same day - not a decision-making conversation.
Reading your operation note
Your operation note in four parts. Read the last one first.
The decision summary the hypertension consultant sends you keeps to the same shape whether you choose the procedure or not.
A quiet reminder
Medical language is precise and can read coldly - we translate it for you.
If you would like us to walk through the evidence with you before your review, just ask.
- 01Header
BP profile and drug list
Baseline office and ambulatory BP, current antihypertensives with doses, and adherence assessment.
- 02Technique
Workup findings
Results of secondary-cause screen, renal artery imaging and sleep study - the checklist that separates true resistance from missed diagnosis.
- 03Findings
Shared-decision summary
What the evidence predicts for you, what the alternatives are, and where you sit on the decision.
- 04Impression
Agreed plan and review point
Read this first: the treatment you chose (procedure, drug optimisation or both), why, and when we look again on ambulatory BP.
Recognised by major UK insurers
The decision consultation and workup are usually covered under specialist cardiology. Procedure cover depends on NICE IPG754 alignment - we check before booking.
Frequently asked
Everything we get asked about renal denervation.
Quick answers on the evidence, selection, expected effect, NHS route and cost.
-
How is this page different from the RDN procedure page?
This is a decision guide - is renal denervation the right idea for you at all, and how does it compare with better drug rationalisation, spironolactone, sleep apnoea treatment and lifestyle change. The sister page - Renal Artery Denervation (RDN) - covers the procedure itself: the cath lab, the devices, the follow-up. Most patients read both, in that order.
-
Do I have to try every tablet before RDN is considered?
You do not have to try every possible drug, but you should have tried a rational three-drug regimen at maximally tolerated doses including a diuretic, and - under UK guidance - usually spironolactone as fourth-line if renal function and potassium allow. Anyone offering RDN without spironolactone having been tried, or contraindicated, is skipping the evidence.
-
Will renal denervation replace my blood pressure tablets?
Usually not entirely. Trials and registries show an average 6–10 mmHg office SBP fall, often allowing one or two drugs to be reduced or stopped. Some patients respond much more, some barely at all. The honest conversation is about ‘fewer tablets, not none’.
-
What if my case is complicated - kidney disease, diabetes, sleep apnoea?
These are not automatic exclusions and, for many, are reasons the decision is worth taking seriously. What matters is that each is addressed before renal denervation is offered - proteinuria monitored, diabetes optimised, sleep apnoea treated with CPAP. That is what a hypertension MDT does.
-
Can I get renal denervation on the NHS?
Yes - NICE IPG754 supports its use in the NHS with special arrangements, and a small number of tertiary centres offer it. Selection is stringent and waiting lists are long. Many patients choose to go private for faster access to the same MDT decision - often, in the end, deciding not to have the procedure at all.
-
What does the private pathway cost if I do decide against the procedure?
A hypertension consultation and shared-decision review is £300–£500. The full workup - ambulatory BP, adherence testing and secondary-cause screen - is £1,200–£2,200. A structured 12-month follow-up package is £950–£1,600. If you decide against the procedure, none of that is wasted; it is the plan you will run with.
Related treatments
Looking for something else?
Renal artery denervation (RDN)
The procedure itself, in detail.
Learn moreCardiac treatments
The wider cardiology service.
Learn moreContinuous positive airway pressure
For obstructive sleep apnoea and hypertension.
Learn moreCoronary artery disease treatment
For coexisting coronary disease.
Learn moreCognitive behaviour therapy
For adherence, anxiety and lifestyle change.
Learn moreAll tests & procedures
Every test and procedure we arrange.
Learn more