What is hypertension
Hypertension, meaning “high blood pressure”, is the term to describe an elevated blood pressure in the absence of identifiable emotional (e.g., a recent altercation) or physical (e.g., pain) stress on the body. Current data suggest that there is a sharp increase in the risk for cardiovascular complications and death when the systolic blood pressure (i.e., the “upper number”) is above 130 mmHg or when the diastolic blood pressure (i.e., the “lower number”) is above 90 mmHg. As such, current guidelines recommend using these parameters when identifying patients requiring treatment.
Why is hypertension important
Hypertension often has no signs or symptoms, and thus frequently goes undiagnosed. Known as “the silent killer”, hypertension is the #1 risk factor for death worldwide. Data from the World Heart Federation indicate that hypertension affects 1 in every 4 adults. Moreover, of those who have been diagnosed, only 1 in every 5 has blood pressure readings that meet the recommended targets. Controlling blood pressure is estimated to lower the risk of stroke by over 35% and the risk of coronary heart disease by over 20%, alongside other major benefits.
Treatment options for hypertension
The initial treatment will always include a shift in behavior. The mainstay is a low-salt diet that (1) is enjoyable and easy to adhere to long-term; and (2) prioritizes fruits and vegetables, limits red meat to special occasions, and minimizes or eliminates highly processed products. Regular exercise, including both “cardio” workouts and strength training, is a must. Weight loss, if overweight or above, also goes a long way in helping blood pressure control.
Several pharmacological agents are available for the management of hypertension. While guidelines published by medical societies have recommendations for optimal therapy, the exact combination a patient will benefit from will vary from individual to individual. In addition, the last decade has shown the benefit of targeting the sympathetic system (i.e., the “stress response” system of the body) to decrease blood pressure. Renal denervation (RDN) therapy is a time-proven, clinical-trial examined, FDA-approved therapy that can be very effective in helping patients achieve blood pressure targets and/or decrease their pill burden.
Renal Denervation Therapy
The kidneys are major sources of signals that activate the sympathetic system. In many patients, decreasing these signals can lead to an average reduction of the systolic blood pressure of -10 mmHg. While this is an invasive procedure, clinical trials have shown that RDN is extremely safe and well-tolerated. In the traditional “no-touch” approach, after adequate anesthesia and pain management, a needle is used to access the arterial system in the groin. Then, either ultrasound or radio-frequency therapy is applied to the artery of the kidney without touching the kidney. This results in up to ~80% reduction in the sympathetic signals the kidney generates that increase blood pressure.
Is Renal Denervation Therapy good for me
Eventually, this therapy may become first- or second-line therapy for anyone diagnosed with hypertension. For now, there are three groups that should consider RDN therapy. First, patients with “resistant” hypertension (i.e., who are uncontrolled while using 3+ medications, one of them a “water pill”) without identifiable causes. Second, patients who are uncontrolled, despite using medications from different classes. And, lastly, patients who are unable to tolerate or adhere to pharmacological therapies due to side-effects or patient-specific factors.
Next Steps
The best way is to get connected with a hypertension specialist who is acquainted with the procedure. Many times, this will involve a referral from your primary care physician. After meeting with the hypertension specialist, optimization of your pharmacological regimen may happen if necessary.
You should expect to undergo some blood tests to ensure there are no abnormalities that, if addressed, could improve or resolve your hypertension. Imaging of the arteries of the kidney will also be performed for the same reason and for procedural planning. At this stage, the hypertension specialist will also make sure that you have no contraindications for the procedure.
Insurance approval times vary, but may take up to several months, depending on your insurance. While the initial request to the insurance company will likely be made early on in the process, these months will be used for optimization of your regimen and the above testing.
