AbstractBackgroundIn most previous studies investigating efficacy of renal denervation (RDN), patients with multiple renal arteries are generally excluded from treatment. This study was designed to determine the prevalence of multiple renal arteries in patients referred for RDN, to propose a classification for anatomical eligibility and to investigate the relation between the presence of multiple arteries and blood pressure (BP)‐lowering effect.Materials and methodsPatients referred for RDN who underwent noninvasive imaging of the renal arteries before treatment were included in present analysis. Eligible patients were treated. Renal function and BP were evaluated 6 months after treatment.ResultsHundred and twenty‐six patients referred for RDN were included in present analysis. Thirty‐four per cent had multiple arteries. Sixty‐nine patients underwent RDN. Office BP significantly reduced from 195 (± 26)/ 106 (± 14) mmHg to 165 (± 24)/ 95 (± 14) mmHg (P < 0·001). BP reduction in patients with multiple arteries which were all treated was comparable to patients with solitary arteries. However, patients with multiple which were not all treated showed a trend towards a less pronounced effect of RDN (β: 11·6, P = 0·11). The proposed classification appeared useful by identifying eligible anatomy. Renal function at 6 months did not differ from baseline in all subgroups.ConclusionsBased on our results and the high prevalence of multiple arteries, it seems reasonable not to exclude patients with multiple renal arteries from RDN. Current analysis suggests that BP reduction may be less pronounced in patients with multiple renal arteries of whom not all arteries were treated.