This site complies with the HONcode standard for trustworthy health information:
verify here.

The use of renal denervation therapy to treat persistent high blood pressure

Professor Carlo Di Mario, Consultant Cardiologist, Royal Brompton Hospital

Hypertension is usually treated with a variety of drugs. However, in some cases patients do not respond to treatment. In this article, Professor Carlo Di Mario discusses the problems, and describes a new highly-successful treatment called renal denervation therapy that uses radio therapy to treat the nerves leading to and from the kidneys.

High blood pressure is a common ailment

Sedentary life, poor diet and obesity, ageing and stress contribute to the increase of the incidence of hypertension, high blood pressure. Almost 12 million people are treated for hypertension in the United Kingdom, and probably many more are unaware of the presence of this silent killer.

Hypertension can be easily monitored

Often, patients seek treatment late, when their heart is already thickened or enlarged, their coronary, carotid or peripheral arteries have narrowed, their aorta is dilated, or they suffered a stroke. Yet regular measurement of blood pressure is as easy as placing a cuff around your arm. Do not be over concerned if your blood pressure is higher than the ideal values of 135/85 mmHg. It might be what is called white coat hypertension, and one high reading is not enough to start prescribing drugs.

The most reliable method of ensuring that hypertension is real and needs treatment is to perform measurements repeated over 24 hours, a method now also strongly recommended by the National Institute of Clinical Excellence.

The use of drugs to control high blood pressure

The National Institute of Clinical Excellence recommend starting treatment with drugs called calcium antagonists or ACE-inhibitors. Patients with hypertension attending a cardiology department may have additional symptoms, prompting doctors to prescribe other drugs called beta-blockers or diuretics.

Often the use of small to moderate doses of two or more drugs in combination work better than using a high dose of a single drug, which may increase side effects without increasing efficacy. Sometimes, three or more of the drugs mentioned above in combination with other classes of drugs are not sufficient to lower the blood pressure within the desired limits. Blood or urine tests and imaging of the kidneys and surrenal glands may reveal that a rare disease is causing the hypertension. Most often, however, these tests are negative and we are left with an uncontrolled or poorly controlled high blood pressure that continues to damage the heart.

Renal denervation can be used to help patients who respond poorly to hypertension drugs

Now there is a non-pharmacological technique available to help patients who respond poorly to drugs called renal denervation. The technique is simple and requires few preliminary tests and one day of hospital stay.

Get a Quote

Cardiology treatments

Get a quote now

Cardiology in your area

Private cardiology clinics

Cardiologists

A thin 2mm tube (catheter) is inserted under local anaesthesia in the groin in the femoral artery and pushed inside the two renal arteries supplying the kidneys to discharge four to six radio-frequency bursts to burn the nerves going to and from the kidneys. During the two minutes of radio-frequency discharge there is pain in the belly which is prevented or reduced by the preliminary or concomitant administration of strong intravenous sedatives, sufficient to control the pain without requiring intubation and true general anaesthesia.

The success rate of renal denervation in the treatment of high blood pressure is high

The method is very safe and works in more than 90% of cases, with an initial reduction of blood pressure which improves progressively in the first six to twelve months after treatment. Recent data from a well conducted randomised trial has shown that the blood pressure improvement is ongoing and with a greater than 10 mmHg reduction for up to 4 years after initial treatment.

In a patient who has already been shown to have refractory essential hypertension, a rise in blood pressure of unknown cause, confirmed by a recent 24 hour blood pressure monitoring under full treatment, a simple non-invasive radiological test called multislice computed tomography (MSCT) is performed to exclude the presence of narrowing of the renal arteries, and to establish the anatomy of the renal arteries to plan the denervation procedure.

Renel denervation therapy is only available after consultation with a group of hypertension and cardiology specialists.

About Professor Carlo Di Mario

Professor Carlo Di Mario, M.D. Ph.D. FESC FACC has been a Professor of Clinical Cardiology, Imperial College of Sciences, Medicine & Technology in London, UK since 2003, and in that year he began consulting in interventional cardiology at the Royal Brompton Hospital in London. He served as an Associate Clinical Director at Centro Cuore Columbus and San Raffaele Hospital, both in Milan, Italy. Prof. Di Mario is Past-President of the European Association of Percutaneous Cardiovascular Interventions, Councillor of the European Society of Cardiology and Senior Investigator of the National Institute for Health Research.

About the Royal Brompton Hospital

The Royal Brompton Hospital is a world-renowned centre for heart and lung disease. Every private patient can be confident that they will have access to the most comprehensive range of advanced surgical, medical and diagnostic facilities that are only available from a large, specialist NHS hospital. The Heart Risk Clinic screening programme includes specialist tests to detect the early stages of heart disease from blood analyses, ECG, exercise ECG to echocardiogram and cardiovascular magnetic resonance. The screening takes around two hours and specialist medical experts are on hand throughout.