In recent years, there have been an increasing number of reports of a new treatment method for resistant hypertension - a procedure called renal denervation. Patients with more severe forms of hypertension, referred to as resistant hypertension, in particular, would benefit from undergoing such a procedure. The assumptions of the method are quite interesting, but in reality it is controversial - according to some scientists, renal denervation allows to achieve significant results, according to others.... the effectiveness of the method is poor.
Arterial hypertension (HTN) is still a disease that is a nuisance for patients all over the world - this also applies to Polish patients. The prevalence of arterial hypertension in Poland is unfortunately still high - even more than 10 million Poles suffer from the condition.
Patients sometimes underestimate high blood pressure - this is particularly the case when the abnormalities concern only excessively high values obtained from blood pressure measurements, while the patient does not feel any symptoms of hypertension. The absence of symptoms, however, does not mean that the patient's condition is good - in the meantime, hypertension can lead to various dangerous consequences, such as damage to the kidneys, the heart or the organ of the eyes.
For these reasons, doctors continue to emphasise the importance of proper treatment of hypertension. Appropriate diet and physical exercise (to limit body weight) are of primary importance in this case, with pharmacotherapy being used if necessary. There are many different hypotensive (blood pressure-lowering) drugs, sometimes even used in combination, and yet the patient does not achieve the expected drop in blood pressure - what can be done?
Renal denervation for the treatment of hypertension: principles of the method
If a patient takes three or more hypotensive drugs (including at least one diuretic) and still has blood pressure values above the target threshold, the patient is said to have resistant hypertension. This condition requires special care of the patient and consideration of the implementation of hypertension treatment methods other than pharmacotherapy.
photo: panthermedia
The part of the nervous system that can lead to increased blood pressure values is the sympathetic nervous system. Its fibres are distributed throughout the body and are also found in the renal arteries. Depriving the kidneys - one of the organs involved in blood pressure control - of sympathetic innervation is therefore intended to lead to a drop in blood pressure. This is the premise of renal denervation for the treatment of hypertension. The procedure may generally resemble procedures that have already been performed in the past, such as sympathectomy. The difference in this case, however, is that renal d enervation is a much more precise procedure, whereas after less precise procedures, such as sympathectomy, patients have experienced quite unpleasant side effects of these procedures, such as episodes of orthostatic hypotonia, sweating disorders or impotence.
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How is the renal denervation procedure performed?
Renaldenervation is a relatively minimally invasive procedure. The procedure is carried out intravascularly: a catheter is inserted into the femoral artery and then, under the control of imaging equipment, it is guided towards the renal arteries. Once the target is reached, a high-frequency current is emitted into the walls of the renal arteries to damage the nerve fibres of the sympathetic nervous system while not damaging the vascular wall itself.
The duration of renal denervation is usually not long - about one hour is usually sufficient. Quite quickly after the procedure, the patient can be discharged home - it is usually possible to leave the hospital the day after the procedure.
Renal denervation: what results can be achieved?
Cutting off sympathetic stimulation in the kidneys, through a relatively uncomplicated procedure, leading to a reduction in blood pressure.... Sounds beautiful enough, is kidney denervation actually effective?
According to some studies, a drop in blood pressure of up to several tens of mmHg can be achieved through the procedure. This is indeed a lot, however, it is not always possible to achieve such satisfactory results. Other authors, on the other hand, point out that sometimes the effects of the procedure are not even noticeable at all - the key in this case seems to be the proper qualification process of patients for kidney denervation.
Possible complications of renal denervation
As after any other procedure, some complications may occur after renal denervation. In general, however, the procedure is considered relatively safe - possible complications include haematoma formation at the femoral artery puncture site, arteriovenous fistula formation and pseudoaneurysm formation of the femoral artery.
photo: panthermedia
Controversy over renal denervation in the treatment of hypertension
Unfortunately, it is not the case that kidney d enervation is enough to forget about hypertension. Well, the procedure does not remove the cause of the condition, but only affects one of the possible mechanisms through which high blood pressure values appear. Even after the treatment, there may still be (and usually is) a need to take previously used blood pressure-lowering drugs. Yes, it may be possible to reduce the doses of these drugs or to dispense with some of them, but complete freedom from pharmacotherapy through renal denervation is unlikely to be possible.
There remains another aspect that may limit the availability of renal d enervation for patients with hypertension. Well, the procedure is not (at least for now) reimbursed by the National Health Fund.
