La dénervation sympathique rénale : une alternative thérapeutique dans des cas bien précis d'hypertension artérielle ?

With the development of endovascular catheter technology, the renal sympathetic denervation can be used to reduce blood pressure in treatment-resistant hypertension. A French consensus gives details on patient' inclusions. The first step is to identify people who have a true resistant hypertension despite four or more antihypertensive drugs including a thiazid diuretic: Factors which predispose to resistant hypertension, such as sleep apnoea, as well as secondary hypertension should be excluded. Renovascular hypertension and renal insufficiency are not candidates for renal denervation. Results published on a series of patients seem to substantially reduce blood pressure, however the duration of observations is short and the long-term efficacy has not been studied. Other beneficial effects on ventricular hypertrophy or on an improvement of the glucose regulation are described with no deleterious change of renal function. The patient should be clearly aware of these data. Future trials will address the effectiveness of renal denervation in larger groups of patients with resistant hypertension or in other diseases such as cardiac failure.