A Study of Renal Denervation in Patients With Treatment Resistant Hypertension

Inclusion Criteria: * Ontario residents * Aged 18 and over * Diagnosis of treatment-resistant hypertension after assessment and optimization by a hypertension specialist following recommended evaluation and diagnosis as outlined by the American Heart Association * Office systolic blood pressure ≥ 160 mmHg (≥ 150 mmHg for patients with type II diabetes mellitus) prior to optimization by a hypertension specialist * Baseline average systolic 24 hour ambulatory blood pressure of ≥ 135 mmHg after optimization and prior to randomization * Prescribed 3 or more antihypertensive medications of different classes, both prior to optimization and at randomization, one of which must be a diuretic (a medication can be counted more than once if it acts on different receptors) * Suitable renal artery anatomy based on CT/MRI/renal angiography imaging: both renal arteries \> 20 mm in length and \> 4 mm in diameter without significant fibromuscular disease or renal artery stenosis (\>50%) Exclusion Criteria: * Secondary causes of hypertension: 1. Primary aldosteronism (secondary to adrenal adenoma) 2. Chronic kidney disease: creatinine clearance or eGFR \< 45 ml/min/1.73m² (measured on 24 hour urine preferably or MDRD) 3. Pheochromocytoma 4. Cushing's syndrome 5. Aortic coarctation (differential in brachial or femoral pulses, systolic bruit) * Type 1 diabetes mellitus * Pregnancy