Many people control their high blood pressure with medication, but that doesn’t work for some.
Baylor Scott & White Heart and Vascular Hospital – Dallas last month began using a recently FDA-approved procedure aimed at treating resistant hypertension.
KERA’s Sam Baker talked about renal denervation with Dr. Robert Stoler, an interventional cardiologist who performed the first surgery in Texas in December.
Stoler was principal investigator at BSW-Dallas for the clinical trial to study the efficacy of the renal denervation system.
How does renal denervation work?
In some patients that have resistant hypertension, the renal nerves that supply the kidneys secrete or put out too much adrenaline or epinephrine, a chemical that raises our blood pressure in essence.
We can take a catheter, which is a thin tube, and we can run it up from the leg or the femoral artery, and we can steer it into the arteries that supply the kidneys, the renal arteries. And we can drive through the renal arteries and use these catheters to use an energy source. One form uses ultrasound. The other uses radiofrequency energy. And we can use those types of energy to modify or burn or downgrade the renal nerves.
And when we modify those nerves using this energy, their ability to release that adrenaline or epinephrine and those other chemicals into our bloodstream, which can elevate the blood pressure goes away.
Does renal denervation cure your high blood pressure?
Renal denervation does not cure high blood pressure. It's one weapon in the arsenal for treating high blood pressure.
In the first year after renal denervation, patients get an average of about a ten-point blood pressure drop on the top number of the systolic number. And the further out we get from the procedure, the more reduction in blood pressure we get.
So, in patients who have resistant hypertension who are on multiple medications, one goal may be to bring the blood pressure under control. The other goal is to reduce the number of medications that the patient is on to control that blood pressure.
You still have to take medications, still have to do the regular kind of management of lifestyle?
Yes, that's right. And most patients who are at least at this stage of renal denervation experience, most who are going to get renal denervation are going to have high blood pressure on multiple medications.
They're going to be trials coming down the pipe, where we look at patients on fewer and fewer medications to see if we can, quote-unquote, cure their hypertension or get them off of all medications after a single procedure.
That data is going to be looked at coming down the line. But the first stage of therapy for, um, using renal denervation is going to be for uncontrollable hypertension on multiple medications.
Would this be more of a last-resort approach?
No, I think we're going to see it more and more become mainstream. In some studies, up to half the population have hypertension, and many of those don't have blood pressure that's under control.
So, there's a host of patients out there who, rather than taking multiple and more and more medications, would like to have a procedure which, hopefully, will bring their blood pressure under much better control rather than escalating many medications going down the line. So I think we're going to see this become more and more mainstream, uh, as word gets out.
It sounds expensive, this procedure. Does insurance cover renal denervation?
The companies that make the devices are currently negotiating with Medicare and payers, um, to get the therapy paid. But right now, we're sort of in a limbo period waiting. It's a case-by-case situation where we, the physicians and our hypertension clinic, wind up speaking with the payers to get them to pay for this therapy. Ultimately, renal denervation is going to be paid for by all the insurers right now. That's a work in progress, I would say.
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