All about renal denervation for high blood pressure

High blood pressure, or hypertension, is a medical condition where the force of blood against artery walls is consistently too high, potentially leading to health complications like heart disease, and in some cases, can be treated with renal denervation. Renowned consultant cardiologist Dr Giovanni Luigi De Maria provides a simple guide to the condition and explains how renal denervation works to treat it.

What is high blood pressure?

In simple terms, blood pressure refers to the force exerted by blood as it flows through your arteries. Like any closed system of circulating liquid, a certain pressure is necessary to maintain correct blood flow.

When your blood pressure is measured, your healthcare provider will consider two numbers:

Systolic pressure: This is the higher number and indicates the pressure when your heart contracts to pump blood.

Diastolic pressure: This is the lower number and reflects the pressure between heartbeats when the heart is at rest.

Hypertension, or high blood pressure, occurs when these numbers consistently exceed normal levels, typically above 140 mmHg for systolic and 90 mmHg for diastolic.

Why is hypertension concerning?

Elevated blood pressure strains arteries, diminishing their elasticity and potentially causing damage to vital organs like the heart, brain, kidneys, and eyes. This heightened pressure increases the risk of severe conditions such as heart attacks or strokes.

Hypertension is often termed a "silent killer" because it often goes unnoticed, lacking obvious symptoms until significant organ damage occurs. Regular blood pressure checks are crucial, particularly for individuals over 40 or those with underlying health issues like diabetes or heart disease.

What triggers hypertension?

While specific causes are elusive, lifestyle factors, genetic predisposition, and existing medical conditions play significant roles. Certain medications, like oral contraceptives, can also elevate blood pressure, necessitating regular monitoring.

What causes hypertension?

The precise cause of hypertension is challenging to determine, but it's believed that lifestyle choices, genetic factors, or existing medical conditions contribute to its development in many individuals. Certain medications, like oral contraceptives, can also elevate blood pressure, necessitating regular monitoring if you're using them.

What is resistant hypertension?

This occurs when blood pressure remains high despite lifestyle adjustments or appropriate medication. Reasons for this resistance vary, from difficulty adhering to medication regimens to physiological factors. Renal denervation may be considered for cases where traditional treatments fail to lower blood pressure adequately.

Is renal denervation treatment suitable for me?

Renal denervation (RDN) is typically recommended for individuals with uncontrolled moderate to severe hypertension who are already on multiple medications or have encountered adverse effects from most blood-pressure drugs. Your GP or consultant cardiologist will assess its suitability for you.

Can I stop hypertension medications after RDN?

The primary goal of renal denervation is not medication cessation but achieving optimal blood pressure control, crucial for reducing stroke or heart attack risks. While dosage or medication numbers may decrease post-procedure, success is also defined by improved blood pressure control, even if some medication continuation is necessary.

Furthermore, RDN may offer the advantage of continuous blood pressure regulation compared to medication adherence variability.

Are there potential complications?

Renal denervation boasts a well-established safety record. Nonetheless, like any invasive procedure, complications are possible. Your cardiologist or GP can provide detailed information.

Rare but serious complications include kidney injury or renal artery narrowing, reported in clinical studies at a rate below 0.5%.

The most frequent side effect is bleeding at the catheter insertion site (groin), with no major bleeding complications reported in clinical studies.

Bruising or hematoma at the entry point is common, causing discomfort for days to weeks post-intervention. However, it typically responds well to pain relief and resolves spontaneously.

What is the duration of the procedure?

The time taken can vary based on vascular anatomy, but typically, the procedure lasts approximately 60 minutes on average.

Will I be conscious during RDN treatment?

The procedure involves delivering energy to disconnect nervous fibres, which can be uncomfortable. Hence, it's conducted under local anaesthesia, analgesia, and deep sedation. Patients are usually unconscious but can breathe independently. Awareness levels vary, with most sleeping throughout.

Will my blood pressure drop immediately?

Your blood pressure won't drop right away after the procedure. It works by resetting connections between the brain and kidney, which takes time. Usually, you'll start seeing results in three to six months, though some may respond sooner. However, like any treatment, about 20% of people might not respond at all. We can't predict who will respond well in advance.

How long does the blood pressure effect last?

Based on current data, it appears to remain stable over time, supported by the observation that nerves around the renal arteries don't regenerate. The strongest evidence indicates a sustained blood pressure reduction for at least three years, with emerging data suggesting the effect may persist even longer.

If you would like to book a consultation with Dr De Maria, do not hesitate to do so by visiting his Top Doctors profile today.