title: Expert consensus: Renal denervation for the treatment of hypertension.
abstract: Catheter-based renal denervation is a new method able to disrupt renal sympathetic nerves located in the adventitia of renal arteries. A randomized clinical trial showed a decrease in blood pressure in resistant hypertensive patients. In order to guide clinicians and interventional practitioner for the use of this new approach, different French scientific societies (Hypertension, Cardiology and Radiology) decided to combine their expertise and propose an expert consensus to assess benefit/risk ratio of this technique in the field of arterial hypertension. In 2012, this expert consensus propose to limit renal denervation technique to patients with essential hypertension uncontrolled by four or more antihypertensive therapies with at least one treatment being a diuretic and spironolactone at a dose of 25mg shown to be unable to control blood pressure. Measurement of office BP should be at least with SBP more than 160mmHg and/or DBP more than 100mmHg confirmed by ambulatory BP measurement (home or ABP measurement with SBP more than 135mmHg and DBP more than 85mm during daytime period). Finally, renal artery anatomy and function should allow proper intervention (i.e., two functional kidneys, absence of previous renal angioplasty). Renal enervation is a complex interventional procedure with potentially arterial complications, training is required for practitioners. Antihypertensive treatment should not be interrupted immediately after renal denervation since blood pressure lowering effect are delayed and reached maximum effect after 3 months. Monitoring of blood pressure, renal function and anatomy of renal arteries is required 12 months and 36 months after procedure. The expert consensus requires the inclusion of patients experiencing this procedure in a observational study with record form and follow-up.
authors.affiliation: Service de pharmacologie, CHU Toulouse, 37, allée Jules-Guesde, 31000 Toulouse, France.
authors.forename: Atul
authors.initials: A
authors.lastname: Pathak
authors.forename: Xavier
authors.initials: X
authors.lastname: Girerd
authors.forename: Michel
authors.initials: M
authors.lastname: Azizi
authors.forename: Hakim
authors.initials: H
authors.lastname: Benamer
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halimi
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefevre
authors.forename: Marc
authors.initials: M
authors.lastname: Sapoval
mesh_terms: D017115:Catheter Ablation; D006801:Humans; D006973:Hypertension / Q000601:surgery*; D007668:Kidney / Q000294:innervation* / Q000601:surgery*; D017410:Practice Guidelines as Topic; D013562:Sympathectomy / Q000379:methods