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
Hypertension can be
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
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.