Guidelines for the appropriate use of renal denervation systems in Japan: endorsed by the Japanese Society of Hypertension (JSH), the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), and the Japanese Circulation Society (JCS), and their positioning in the JSH 2025 guidelines.

This document presents the Guidelines for the Appropriate Use of Renal Denervation (RDN) Systems in Japan, jointly endorsed by the Japanese Society of Hypertension (JSH), the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), and the Japanese Circulation Society (JCS). Based on the final consensus statement of the Joint Committee on RDN, these guidelines identify resistant hypertension as the principal indication for RDN treatment in Japan. Indicated resistant hypertension is strictly defined as uncontrolled blood pressure, confirmed by both office and out-of-office measurements (ambulatory blood pressure monitoring or home blood pressure monitoring), despite lifestyle modification and appropriate antihypertensive therapy with three or more drug classes, including a diuretic. RDN procedures should be performed by a multidisciplinary Hypertension Renal Denervation Treatment (HRT) team, composed of JSH-, CVIT-, and JCS-certified specialists, nurses, pharmacists, and registered dietitians, within accredited centers providing accessible outpatient care. Using standardized checklists and procedural manuals, the HRT team thoroughly evaluates lifestyle factors, pharmacological therapy, and patient background, and determines the indication for RDN based on a shared decision-making process with each patient. The Japanese Society of Hypertension Guidelines for the Management of Elevated Blood Pressure and Hypertension 2025 (JSH2025) explicitly state that RDN may serve as a novel adjunctive treatment option for resistant hypertension (recommendation strength: 2, evidence strength: B, consensus rate: 100%). This recognition represents a pivotal step toward integrating RDN into clinical practice in Japan. Moving forward, the Joint RDN Committee will revise and update indications and implementation guidance as appropriate, informed by real-world clinical evidence.