Endovascular renal denervation in the treatment of arterial hypertension: An update

. - The estimated prevalence of arterial hypertension (HTN) is 31 % of the French adult population (17 million of people). HTN is one of the main cardiovascular risk factors. Despite the availability of various classes of antihypertensive drugs, HTN remains insufficiently controlled for various reasons, including patients' non-adherence to treatment and therapeutic inertia. In this context, and in the absence of new medication therapies on the horizon, device-based therapies including catheter-based renal denervation [RDN] have been proposed for the management of HTN. RDN uses a dedicated catheter sequentially introduced through the femoral route in each renal artery to deliver focused ultrasound (US) or radiofrequency (RF) energy, causing thermal ablation of the sympathetic nerves in the adventitia of the renal arteries. The first randomized controlled trials using first-generation catheters yielded highly heterogeneous results in terms of blood pressure efficacy. However, from 2017 to 2023, six well-conducted randomized controlled trials in patients with mild-to-moderate HTN or HTN resistant to treatment consistently demonstrated a clinically relevant reduction in blood pressure at short, medium, and long-term follow-ups after RDN with an optimized second-generation catheter using UF or RF, compared to a sham intervention. RDN conveys a minimal risk of complications at the femoral arterial puncture site. With the positive results of the latest trials the latest European guidelines recommend RDN to be used as adjunct treatment option to lifestyle and pharmacological interventions in patients with severe, resistant, or complicated HTN. (c) 2024 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.