A Permanent Fix for Hypertension? DeepQure's Approach to Renal Denervation

Finally, an effective, permanent cure for hypertension?

Globally, 1 in 3 adults have hypertension. The disease is a major risk factor for conditions including stroke, heart failure, and dementia, making it the leading cause of death worldwide. Drugs are currently the most common intervention for hypertension. Beyond pharmacological solutions, however, there is also renal denervation (RDN). The procedure traces its origins to the 1940s as one of the earliest innovations in hypertension management, but has since been overshadowed by pharmaceuticals due to the latter’s proven efficacy and lower risks.

Drugs are de rigueur for hypertension, but a more effective and permanent treatment is in sight.

Recent breakthroughs have returned RDN to the spotlight though. In particular, South Korean startup DeepQure is currently leading the pack with a radically different approach to RDN, which has the potential to transform the clinical landscape and reshape hypertension treatment.

RDN: The Basics

The kidneys are part of the sympathetic nervous system, and inputs from the latter regulate its various functions. This includes haemodynamics – the movement and flow of blood in the body – which affects the body’s blood pressure.

Overactivation of the sympathetic nervous system contributes to hypertension by increasing vasoconstriction and heart rate, which raises a patient's blood pressure. (Souce: Cardiovascular Institute of America)

RDN works by ablating (i.e. surgically removing) the nerves on the renal arteries supplying the kidneys with blood. Doing so reduces the kidney’s sympathetic nervous activity and, in turn, lower the patient’s blood pressure.

Although the above mechanism is well-understood, the process of proving RDN’s clinical efficacy has been wrought with difficulties. In particular, one major setback occurred in the 2010s when an important clinical trial was carried out with significant design flaws. The results gathered from that trial ended up casting doubt on RDN’s effectiveness, which shook the medical community’s confidence in the procedure. This prompted several medical device companies to divest their RDN product divisions, and stalled progress significantly.

RDN Today

Despite an industry-wide slowdown in R&D, work on RDN continued, and two devices for performing the procedure are available today, from Medtronic and ReCor respectively. Operating principles are similar: the surgeon first inserts the device into the renal artery using a catheter, then uses it to perform radiofrequency or ultrasound ablation on the nerves running along the outer walls of the artery.

As ablation is done through the artery walls, the current form of RDN faces some technical limitations. For one, renal arterial size and structure differ among individuals, which often precludes hypertensive patients with smaller arteries or complex artery structures, as catheters simply cannot reach these accessory and/or branched arteries. Incomplete ablation is another issue, given the challenge of targeting the renal nerves from inside the renal artery. A third problem concerns risk; it is possible to damage the inner walls of the renal arteries during RDN as energy is directed through the artery wall to reach the nerves.

An estimated 50% of the population have renal artery structures that are unsuitable for catheter-based RDN

Despite these challenges, RDN is still the most promising treatment option for patients with resistant or refractory hypertension, as the intervention works completely differently from pharmaceuticals and lifestyle changes. Instead of returning to the drawing board, an evolution of this technology is needed to deliver better patient outcomes.

The Direct Approach

South Korean startup DeepQure has developed HyperQure, a medical device that offers a radically new approach to RDN. The key difference? Directly ablating the renal nerves from the outside of the artery.

DeepQure's HyperQure RDN system

HyperQure’s extravascular approach is the first and only one on the market, and uses established laparoscopic techniques to access the renal arteries via the lower back. Once in position, the device coils/loops around the artery and delivers energy directly to the nerves being targeted, for more complete denervation without the associated damage to the artery’s tissues typical of catheter-based RDN.

HyperQure's extravascular approach performs RDN directly on the renal nerves, instead of delivering energy through the artery walls like current solutions

Thanks to its direct application of energy, HyperQure does not face the limitations inherent to catheter-based RDN. Instead, more complete denervation can be accomplished across different patients’ varied artery sizes and structures – with minimal arterial damage too.

HyperQure’s safety and efficacy profiles are being studied, and results are very promising indeed. Currently, first-in-human trials are ongoing in South Korea, with 7 patients treated so far, while Early Feasibility Studies have also begun in the US with 1 patient undergoing the same procedure.

Interim results from these studies show significant reductions in all patients’ blood pressures and, consequently, a reduction in medications taken for most of them. More importantly, no adverse effects have been observed whether during or post surgery, even after 12 months, thus proving HyperQure’s safety.

The Demand for Renal Denervation

With hypertension being the leading cause of death worldwide, there is a massive market for a safe, effective treatment beyond pharmaceuticals. Unsurprisingly, RDN is the frontrunner given its potential to permanently reduce a patient’s blood pressure.

Yet despite the existence of two approved RDN devices on the market, neither has become the standard of care due to their technical limitations. Instead, the search continues, with high profile acquisitions of RDN technologies over the years pointing to continued interest in the space.

The latest is Boston Scientific’s acquisition of SoniVie, an Israeli company developing Therapeutic Intravascular Ultrasound (TIVUS) for RDN, in early March 2025. Valued at US$540 million, the deal saw Boston Scientific buying out the remaining 90% of SoniVie’s shares, with further payments contingent upon future regulatory milestones.

For context, past acquisitions from 2010 to 2018 have seen deal sizes ranging from US$230 million to US$800 million. More interestingly, they have all been inked while the respective innovations were still undergoing feasibility studies – a milestone that DeepQure is expected to reach within 2 years.

HyperQure remains the only extravascular RDN solution under development

Will DeepQure break all previous records with an exit higher than US$800 million? That remains to be seen. The potential is there though – HyperQure is, after all, the sole device that offers an extravascular approach to RDN treatment. On a more fundamental level, it looks to finally be the decisive step forward for hypertension treatment, and the solution millions of hypertensive patients worldwide are waiting for.