Catheter-based renal denervation in the treatment of arterial hypertension

Atul Pathak, Romain Boulestreau, Marc Sapoval, Pierre Lantelme, Beatrice Duly-Bouhanick, Hakim Benamer, Theodora Bejan-Angoulvant, Antoine Cremer, Laurence Amar, Nicolas Delarche, Olivier Ormezzano, Pierre Sabouret, François Silhol, Philippe Sosner, Marilucy Lopez-Sublet, Ariel Cohen, Pierre-Yves Courand, Michel Azizi

Several high-quality, randomized, sham-controlled trials have provided evidence supporting the efficacyand safety of radiofrequency, ultrasound and alcohol catheter-based renal denervation (RDN) for reducingblood pressure (BP). A French clinical consensus document has therefore been developed to propose guidance for the appropriate use of RDN in the management of hypertension along with a dedicated care pathway and management strategy. The French experts group concluded that RDN can serve as an adjunct therapy for patients with confirmed uncontrolled, resistant essential hypertension despite treatment with ≥ 3 antihypertensive drugs, including a long-acting calcium channel blocker, a renin-angiotensin system blocker and a thiazide/thiazide-like diuretic at maximally tolerated doses. Patients should have (1) an estimated glomerular filtration rate of ≥ 40 mL/min/1.73 m2; (2) an eligible renal artery anatomy on pre-RDN scans and (3) exclusion of secondary forms of hypertension. Additional indications might be considered for patients with difficult-to-control hypertension. Any indication of RDN should be validated by multidisciplinary hypertension teams consisting of both hypertension specialists and endovascular interventionalists in European Society of Hypertension (ESH) Excellence Centres or ESH-BPclinics. Patients should be informed about the benefit/risk ratio of RDN. Expertise in renal artery interventions and training in RDN techniques are needed for endovascular interventionalists conducting RDN procedures while centres offering RDN should have the necessary resources to manage potential complications effectively. Lastly, all patients undergoing RDN should have their data collected in a nationwide French registry to facilitate monitoring and evaluation of RDN outcomes, contributing to ongoing researchand quality improvement efforts.

• Renal denervation
• Hypertension
• Care pathway
• Guidelines

• Abbreviations
• Background
• Pathophysiological basis
• What have we learned from the second-generation trials?
• Indications for RDN
• Organization of the RDN procedure
• Follow-up
• The need for a French Registry of RDN (France-RDN)
• Health economic considerations
• Perspectives

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