Percutaneous renal denervation has emerged as an effective adjunct in the management of resistant hypertension. However, the limits of the renal anatomical criteria that can be successfully treated are still unknown. In this report, we describe the case of a middle-aged man with essential resistant hypertension and two small left accessory renal arteries that underwent renal denervation of both principal renal arteries. He responded well with a progressive reduction in blood pressure measuring of 16/10, 32/17 and 45/24 mmHg at 1, 6 and 12 months, respectively. At 12 months, 94% of ambulatory measurements were below 140/90 mmHg and the number of anti-hypertensive medications had decreased from six to three. Thus, it would appear that the presence of two non-ablated left accessory renal arteries does not influence the response to renal denervation.
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