Expert consensus: renal denervation for the treatment of arterial hypertension

Abstract

Catheter-based renal denervation is a new method for disrupting renal sympathetic nerves in the adventitia of renal arteries. A randomized clinical trial showed a decrease in blood pressure (BP) in resistant hypertensive patients. To guide clinicians and interventional practitioners in the use of this new approach, the French Societies of Arterial Hypertension, Cardiology and Radiology decided to combine their expertise and propose a consensus document assessing the benefit/risk ratio of this technique in arterial hypertension. In 2012, this expert consensus proposed limiting renal denervation to patients with essential hypertension uncontrolled by four or more antihypertensive therapies and with: treatment that includes at least a diuretic; past or present exposure to spironolactone (at a dose ≥ 25 mg/d); and office BP greater or equal to 160 mmHg and/or 100 mmHg for systolic and diastolic BP, respectively, confirmed by daytime ambulatory or home BP measurement, with systolic BP greater than 135 mmHg and diastolic BP greater than 85 mmHg. Finally, renal artery anatomy and kidney function should allow proper intervention (i.e. two functional kidneys, absence of previous renal angioplasty). Renal denervation is a complex interventional procedure requiring appropriate training and associated with arterial complications. Antihypertensive treatment should not be interrupted immediately after renal denervation as the BP-lowering effect is delayed and reaches maximum effect after 3 months. Monitoring of BP, renal function and renal artery anatomy is required 12 months and 36 months after the procedure. The expert consensus requires the inclusion of patients experiencing this procedure in an observational study.