Hypertension arterielle refractaire et denervation renale : Fantasme ou realite.

Sympathetic hyperactivity is involved in the early stages of hypertension (HTN) and the mechanism persists during the course of HTN until organ damage and significant increase in cardiovascular risk. Radiofrequency renal denervation (RDN) using a percutaneous catheter inserted into the renal artery helps to destroy adventitial sympathetic nerve fibers, interrupting the connections between the renal sympathetic system and the central nervous system. After the first very encouraging clinical results in a small number of patients, the SIMPLICITY HTN-3 study halted the expansion of the technique because of negative results. From there, the technique has been redesigned conceptually as well as technically with the development of a new quadripolar spiral catheter. The first results of the SPYRAL program show this time a proven efficacy in hypertension and a larger study is underway. The results of this trial will help us to decide definitively on the future of this technique. Other pathologies such as heart failure, atrial fibrillation, obstructive sleep apnea and insulin resistance could also be improved by the RDN and studies to demonstrate this are ongoing.