Hypertension, commonly known as high blood pressure, affects a significant portion of the global population and is a leading risk factor for serious health problems like heart attack, stroke, and kidney disease. While many individuals can manage their blood pressure through lifestyle adjustments and medication, some face a condition called resistant hypertension. This occurs when blood pressure remains elevated, typically above 130/80 mmHg, despite the consistent use of three or more different antihypertensive medications, including a diuretic, at their maximum tolerated doses. For these individuals, new treatment approaches such as renal nerve denervation are being explored to help achieve better blood pressure control.
Understanding Renal Nerve Denervation
Renal nerve denervation (RND) is a minimally invasive procedure designed to reduce the overactivity of nerves located in and around the kidneys. These nerves, part of the sympathetic nervous system, play a role in regulating blood pressure by sending signals to and from the kidneys.
In individuals with resistant hypertension, these renal nerves can become overactive, contributing to persistently high blood pressure by influencing processes that elevate it. By disrupting these overactive nerve signals, RND aims to interrupt the communication between the kidneys and the central nervous system, thereby helping to lower blood pressure.
The Procedure
Renal nerve denervation is a catheter-based procedure performed in a hospital setting, typically lasting about one to two hours. It begins with a small incision in the groin to access the femoral artery.
Through this incision, a thin, flexible tube (catheter) is guided through blood vessels to the renal arteries, which supply blood to the kidneys.
Once positioned, energy is delivered to the vessel walls to disrupt the surrounding nerves. Common methods use either radiofrequency (heat) or ultrasound energy, ablating nerves without damaging the artery. Energy is applied at several points along the renal artery for comprehensive nerve signal disruption.
Effectiveness and Patient Suitability
Renal denervation aims to reduce blood pressure, particularly in patients with resistant hypertension. Studies show RND can significantly reduce blood pressure, both in office and ambulatory settings. While it does not cure hypertension, it can substantially lower blood pressure, potentially reducing the reliance on multiple medications.
Individual responses to RND vary, with some patients experiencing a noticeable drop and others less change. A majority of patients experience a meaningful blood pressure decrease.
The procedure is reserved for those with resistant hypertension who have not achieved adequate blood pressure control despite optimal treatment with multiple medications. Candidates typically have healthy renal arteries and kidneys. A thorough medical evaluation by a specialist determines suitability.
Safety and Important Considerations
Renal nerve denervation is a low-risk, minimally invasive procedure with a low complication rate. Potential complications are minor, such as bruising or bleeding at the access site. Serious complications are rare.
After the procedure, patients have a short hospital stay, often discharged the same day or the following day. Recovery is quick, with patients advised to avoid strenuous activity for a few days.
Ongoing blood pressure monitoring and continued follow-up with healthcare providers are important. RND is not a substitute for healthy lifestyle changes or other necessary medications, which should be continued as prescribed.