Renal Denervation Therapy
New Hope for patients with difficult to control High blood pressure
PROF UPENDRA KAUL
High blood pressure or hypertension is a very common medical problem in the community. Every 3rd or 4th person above the age of 30 years in the community in our country are reported to have blood pressures more than 140/90 mms Hg. This has been reported in several studies from all over South Asia. These persons are candidates for starting medical treatment in the form of tablets. Persons who have blood pressures more than 160/100 need to be started straight away on two different drugs. There are many patients who need more 3 drugs to bring the BP less than 140/90 mms Hg.
Controlling BP optimally is very important to prevent serious complications like heart attacks, strokes kidney failure and problems of vision. Patients with associated problems like diabetes and high cholesterol levels need a holistic treatment of all the problems to get the best results.
In spite of all the efforts to control the blood pressure by drugs and life style management there are a significant number of patients who continue to have blood pressures more than 160 mms Hg. These are the patients who become very high risk fir strokes and heart attacks. A very heartening development has occurred during the last few years and this is the technique of Renal denervation therapy. These patients are termed to be suffering from Resistant Hypertension.
Renal Denervation Therapy:
The basis of this therapy is to remove the sympathetic nerve supply of both the kidneys by a simple non surgical catheter based technique. Arteries supplying the kidneys one each on one side are the vessels which contain the sympathetic nerves in their walls. Therefore these arteries are subjected to the procedure of renal denervation.
The procedure involves putting a catheter inside the renal arteries and giving short currents to burn off sympathetic nerve terminals outside the arteries at multiple places. It has no side effects and reduces blood pressure over a few months. The current source is very safe radio frequency energy which is also in various other forms of problems like palpitations (R F Ablation). The results from several clinical trials have been extremely encouraging. The blood pressure on an average falls by around 20 mms Hg within a few weeks and is maintained at lower levels and not only controls but also reduces the dose of some medicines which they have been taking for years. Safety record has been very good.
This treatment is going to start in India very soon and 40 patients will be studied in 10 different centers from the country. At Fortis Vasant Kunj hospital the author is one of the key investigators. Following this study which is being done for the drug controller general of India the treatment is expected to be available in several parts of the country. The current device for carrying out this procedure is called the Symplicity Renal denervation system from Medtronic, a well known multinational company for making heart pacemakers, defibrillators and coronary stents etc. It is hoped that many other companies will follow suit and competition always brings the costs down and improves the quality of the equipment used.
Author is Executive Director and Dean Fortis Hospital Vasant Kunj, New Delhi. Reach him at firstname.lastname@example.org
Lastupdate on : Tue, 29 Jan 2013 21:30:00 Makkah time
Lastupdate on : Tue, 29 Jan 2013 18:30:00 GMT
Lastupdate on : Wed, 30 Jan 2013 00:00:00 IST
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