Keeping Blood Pressure Under Control is Critical: A New Option for Tough Cases
The Importance of Blood Pressure Control
About half of U.S. adults have high blood pressure, a major risk for heart attacks, strokes, kidney failure, and even dementia. Many people don’t even realize they have hypertension until it’s done serious damage. As Dr. Randy Zusman of Massachusetts General Hospital stresses, "Know your blood pressure, know the numbers." The American Heart Association recently deemed renal denervation a promising option for patients whose blood pressure remains high despite multiple medicines.
What is High Blood Pressure?
Two numbers describe blood pressure: the top, "systolic" pressure, is the force blood puts on the walls of arteries as it’s pumped out of the heart. The bottom "diastolic" number measures that same pressure but between heartbeats. Normal is less than 120 over 80. Blood pressure naturally fluctuates throughout the day, higher when you’re physically active or stressed. But when it stays high — consistently 130 over 80 or higher, according to the most recent guidelines — it stiffens arteries and makes the heart work harder.
How to Measure Blood Pressure
It doesn’t take a doctor’s visit. Pharmacies and sometimes even libraries offer screening, and people can use at-home monitors. To avoid falsely high readings, the American Medical Association has tips: sit quietly with feet on the floor, legs not crossed. Place the cuff on a bare arm, not over clothing. Don’t dangle the arm — rest it on a table.
Drugs aren’t the Only Way to Treat High Blood Pressure
Lifestyle changes are the first step, especially for otherwise healthy people. Guidelines urge losing weight, exercise, eating more fruits and vegetables, limiting salt and alcohol, and taking steps to handle stress. Medicine is a must once hypertension reaches 140 over 90. The average patient requires two or three drugs, sometimes more, along with healthier living, Zusman said.
What is Renal Denervation?
Doctors thread a small catheter, or tube, through blood vessels to reach the kidneys, and then beam in ultrasound or radiofrequency energy. Those pulses pass through the renal arteries to selectively target surrounding nerves, said Dr. Joseph Garasic, a Mass General interventional cardiologist who performed Garrity’s procedure. It takes about an hour. Although already used in other countries, a key U.S. trial of renal denervation failed about a decade ago, prompting changes before researchers tried again. In November 2023, the FDA approved two catheter systems, from Recor Medical and Medtronic.
The Procedure and Its Results
It’s not a cure – and some patients get no benefit. But Garasic said multiple studies show on average an 8 to 10-point drop in blood pressure, a modest but important improvement. Some like Garrity see a bigger drop, enough to gradually scale back medications. The FDA deemed the procedure safe for carefully chosen patients — it wasn’t tested in those with kidney disease or narrowed arteries, for example. And studies have lasted only a few years, not long enough to tell if the nerves might eventually regenerate.
Conclusion
Keeping blood pressure under control is critical. While lifestyle changes and medication are essential, renal denervation offers a new option for tough cases. As Dr. Garasic emphasizes, it’s crucial to have "thoughtful and informed discussions" to decide who’s a good candidate. With the FDA’s approval, more hospitals like Mass General Brigham are cautiously offering this minimally invasive procedure, which may help patients like Michael Garrity, who’s thrilled to have his blood pressure under control for the first time in years.
Frequently Asked Questions
- What is renal denervation?
Renal denervation is a minimally invasive procedure that targets overactive renal nerves to help regulate blood pressure. - Who is a good candidate for renal denervation?
Patients with treatment-resistant hypertension, those who have not achieved adequate blood pressure control despite multiple medications, and those with a high risk of cardiovascular events. - Is renal denervation a cure for high blood pressure?
No, it’s not a cure. But it can help reduce blood pressure modestly, which may enable some patients to scale back their medication regimen. - Is renal denervation safe?
Yes, the FDA has deemed it safe for carefully chosen patients, but more studies are needed to assess its long-term effects and potential risks.
