Putting pressure on resistant hypertension

As the poet Robert Burns famously observed, even the best-laid plans can go awry. Like when a patient with high blood pressure takes their medications, exercises, manages their weight, complies with recommendations such as reduced salt intake and gets treatment for associated conditions like sleep apnea—all to no avail. Such is the case for the roughly 10.3 million Americans facing resistant hypertension. That’s when providers must think outside the pill box.

A new approach

Roper St. Francis Healthcare recently began offering a new procedure to help patients in exactly this situation. “The FDA approved renal denervation within the last 12 months,” says general and interventional cardiologist Dr. Scott Woodfield. “This procedure is intended for patients who have tried for months or years to control their blood pressure using medications and lifestyle adjustments but still can’t get their hypertension under control. It’s not for those with easy-to-treat high blood pressure.”

Mixed signals

The kidneys help regulate blood pressure in many ways, one of which involves the renal (kidney) nerves sensing blood pressure and signaling the brain to adjust as needed. Sometimes though, often for unknown reasons, overactive renal nerves incorrectly tell the body to increase blood pressure. Cardiologists can use renal denervation to shut off those improper signals.

The solution

The outpatient procedure employs an electrode affixed to a catheter to apply radiofrequency waves and deactivate renal nerves. Similar to an ablation, “the technique is an evolution of other common procedures used to fix blockages in the arteries, such as placing balloons or stents,” says the cardiologist, noting that there’s little risk of complications. And the only necessary prep, he adds, is to “show up.” Patients go home the same day and need just a few days of recuperation while the incision site on the groin heals.

In fact, the trickiest part of the whole process may be getting insurance approval. “Since the procedure is new, there can be pushback,” says Dr. Woodfield. “It may take some effort on the medical team’s part, but we usually win in the long run.”

Positive outlook

Speaking of long runs, renal denervation has proven quite effective up to five years. “We don’t yet have data beyond that,” notes the doctor. While the procedure is not a substitute for blood pressure medications, it typically makes them more effective at controlling hypertension. Some patients may also be able to reduce their medications.

If you’ve been facing resistant hypertension, talk to your primary care physician or cardiologist to find out if you’re a candidate for renal denervation.

To learn more, visit www.rsfh.com/partners/cardiology-services/coastal-cardiology/.