New treatment could change hypertension control

March 16, 2012 12:25:42 PM PDT
An estimated 68 million Americans have high blood pressure and about 20 percent can't get it under control.

That can have life threatening consequences, including increased risk of heart attack and stroke.

Now some doctors say a minimally invasive treatment could revolutionize the way hypertension is controlled.

Trudi Gombar has tried it all. Diet, exercise and a wide assortment of medications, but her stubborn high blood pressure refuses to come down.

"It's frustrating," Gombar said. "I'm on seven different BP medications right now."

Gombar has what is known as treatment resistant hypertension. That means despite trying three or more medications, her blood pressure remains elevated. She says it came on suddenly several years ago.

"It fluctuates some but it's always high," she said. "It's never normal. It's always180 or above."

Then she learned about a possible long term solution.

Doctors at Edward Hospital in Naperville are helping test an experimental procedure called renal denervation.

"I think it's one of the most exciting innovations in the last 20 years," said interventional cardiologist Dr. Mark Goodwin.

Scientists have known for years that nerves around the kidneys play a role in blood pressure regulation by influencing chemicals as well as blood flow in the kidneys.

Destroying these nerves might lower blood pressure permanently.

"So what we are trying to do is interfere with that nerve impulse to the kidney and from the kidney to the brain to help lower blood pressure," Goodwin said.

In renal denervation, a tube is inserted in the groin area and threaded to arteries to cut off nerves running to the kidneys.

That's done by delivering bursts of radiofrequency energy, a kind of heating technique.

"Do little tiny ablations or burns at different areas of the artery to try and kill the nerve tissue in that area," said Goodwin.

This ablation procedure is similar to one that's been used in the heart for years to treat rhythm problems. The Midwest Heart Foundation is also helping test this approach.

"There are no permanent effects on the kidney arteries," said Dr. Joseph Marek, cardiologist at Midwest Heart Foundation. "They don't narrow as a result of this and so there appears to be no adverse long term consequences of doing that. And you know, the amount of energy that they deliver here is very small, this microwave energy they use. "

In previous studies, some patients saw a significant drop in the blood pressure within three to six months. In some, the reduction remained two years out.

If proven effective and safe, it could be a game changer for many more hypertension patients.

"So if you are on two or three drugs perhaps at some point in the future this treatment would be an option to help you reduce the amount of medication you take," Marek said.

It's a blind study, which means patients won't know if they got the procedure until the end. Gombar has been part of the trial for about a month. She says if she didn't actually get the ablation, she will go back to give it a try.

"I will have it because i have faith that it's gonna work," she said.

While some maintain eliminating the nerves poses no risks there are doctors who won't be convinced until there's long term follow up.

This latest research is sponsored by Medtronic which makes a device to perform renal denervation.

Edward Hospital
Midwest Heart Foundation (advocate medical group)
Rf ablation study
(630) 873-3403
lea.elder@advocatehealth.com

Medtronic
Renal denervation
www.symplifybptrial.com

To be considered you have to be between 18 and 80 years old, and be taking three or more high blood pressure medications, including one diuretic.

Blood pressure readings with the higher number of at least 160.

University of Chicago Medicine
Contact Melanie Norstrom at the University of Chicago Medicine at 773-702-0347
Or by email at mnorstrom@medicine.bsd.uchicago.edu

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