Renal denervation
Evidence is growing that a catheter-based therapy may offer an important new treatment option for patients suffering from uncontrolled hypertension. The treatment, called renal denervation (RDN) targets the sympathetic nerves lying in the adventitia of each renal artery.
Background information
Hypertension (HTN) or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and diastolic. Normal blood pressure is 120/80 mm/Hg. The first figure is the systolic blood pressure, the pressure there is in the arteries when your heart is contracting. The second, or lower figure, is the diastolic blood pressure, which is the pressure in your arteries between heart beats. High blood pressure is anything above 140/90 mm/Hg. Hypertension is the opposite of hypotension.
Hypertension is classified as either primary (essential) hypertension or secondary hypertension; About 90–95% of cases are categorized as “primary hypertension,” which means high blood pressure with no obvious medical cause. The remaining 5–10% of cases (Secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.
Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a leading cause of chronic kidney failure. Moderate elevation of arterial blood pressure leads to shortened life expectancy.
Treatment
Lifestyle modifications
- Dietary changes
- Physical exercise
- Weight loss
Medications
Often multiple medications are needed to be combined to achieve the goal blood pressure.
- The first line antihypertensive supported by the best evidence is a low dose thiazide-based diuretic.
- ACE inhibitors
- alpha blockers
- angiotensin II receptor antagonists
- beta blockers
- calcium channel blockers
- direct renin inhibitors
- Glyceryl trinitrates which has the activity of vasodilation, thus controlling high blood pressure.
Renal denervation by Radiofrequence ablation
During the procedure a fine pliable tube (catheter) is fed via an artery in the groin area in the renal arteries. A line is then passed into the artery and with the assistance of a small electric current the renal nerves situated in the artery wall are ablated. This puts a stop to the flawed signals arising from the brain that tell the nerves to maintain high blood pressure.
The highlight of this procedure is that there is no form of harm done to the renal artery or the kidneys. Though the two renal arteries need this form of treatment, however the surgery merely involves a simple slit on the right side of the groin region with merely a small post-operative mark on the patient’s skin.
This procedure appears quite effectual. Though there could be re-growth of the nerves, there is no proof of whether they would re-acquire functionality. There is hardly any risk of blood loss or harm and is risk-free.
Indication
Severe intractable hypertension despite at least 3 medicament.
To learn more about a renal denervation don’t hesitate to call us at tel +45 76 95 01 00