High blood pressure (hypertension) is a common condition. Despite the availability of several medications, many patients continue to have poorly controlled blood pressure. Renal denervation (RDN), a minimally invasive procedure that reduces overactive kidney nerves, has emerged as a potential treatment for certain patients with difficult-to-control hypertension. However, not all patients benefit from this procedure, and there is currently no reliable way to predict who will respond.

The VITAL-RDN study (Virtual twins as tools for personalized clinical care in renal denervation - Pilot study) aims to test whether a "digital twin" can help predict which patients are most likely to respond to renal denervation. A digital twin is a personalized computer model built from an individual patient's clinical, biological, and physiological data. It is designed to simulate how that patient's cardiovascular system functions and how it may respond to treatment.

The main objective of this pilot study is to evaluate whether the digital twin can accurately distinguish between patients who will respond to renal denervation and those who will not. A responder is defined as a patient whose daytime systolic blood pressure decreases by at least 5 mmHg three months after the RDN.

Three groups of patients will be enrolled:

30 patients with resistant hypertension or other clinical indications for renal denervation.

20 patients with untreated primary hypertension who are starting blood pressure-lowering medication.

10 patients with primary aldosteronism who are scheduled for surgical adrenalectomy.

In addition to evaluating prediction of response to renal denervation, the study will also assess the performance of the digital twin in predicting response to antihypertensive medication or adrenalectomy in the respective subgroups.

If successful, this approach could support more personalized treatment decisions, reduce unnecessary procedures, and improve blood pressure control by matching the right therapy to the right patient.

General inclusion criteria:

• Age between 18 and 90 years for both sexes.
• Patient information and verbal non-opposition expressed by the patient, recorded in writing on the non-opposition form by the investigator.
• Patients affiliated with social security or an equivalent scheme.

Specific inclusion criteria:

Patients with clinical indication for RDN:

• Stable treatment for at least 1 month.
• Clinical indication for RDN according to current recommendations or clinical judgment, as part of routine care.

Patients with untreated primary hypertension:

• Treatment-naïve hypertensive patients or continuous antihypertensive treatment for < 6 months.
• Office BP >140/90 mmHg in repeated measures or office BP >140/90 mmHg in a single visit and home BP or daytime 24h-ABPM BP >135/85 mmHg.
• Clinical indication to start antihypertensive treatment.

Patients with clinical indication to surgical adrenalectomy:

• Confirmed diagnosis of primary aldosteronism according to current guidelines.
• Clinical indication for monoliteral surgical adrenalectomy.

Exclusion Criteria:

• Pregnancy.
• Presence of skin irritation or non-intact skin at sensor attachment sites (sternum, chest, finger) preventing the possibility to pose sensors.
• Known allergies to ultrasound gel, adhesives, Ag/AgCl electrodes, metals, or plastics.

Patients included in this study are recruited from the active patient population regularly seen in outpatient consultations or during hospitalization at the Hypertension Unit or the Pharmacology Unit of the Georges Pompidou European Hospital (Paris - France)

Individual participant data (IPD) that underlie results in publication could be shared. IPD detailed in the protocol of a planned metaanalysis could be shared

Two years after the last publication

Data sharing must be accepted by the sponsor and the PI based on a scientific project and scientific involvement of the PI team. Collaboration will be fostered. The founder and other collaborators could be involved in the decision.

Teams wishing obtain IPD must meet the sponsor and IP team to present scientifics (and commercial) purpose, IPD needed, format of data transmission, and timeframe. Technical feasibility and financial support will be discussed before mandatory contractualization. Processing of shared data must comply with European General Data Protection Regulation (GDPR).