Renal Denervation Therapy - A new
Treatment for Resistant Hypertension
64 year old
farmer from Nellore with a history of blood pressure and diabetes had a sudden
episode of inability to use his left upper and lower limbs and was found to
have very high blood pressure – 220/130mmHg. CT scan confirmed that he had a
damage in a small region of the brain – an infarct. The neurologist had
recommended that his blood pressure had to be controlled as failure to do that
could increase the damaged area. Anti hypertensive medications were started
orally as well as by intravenous route but to no avail. Despite the use of five
different types of drugs the blood
pressure could not be controlled satisfactorily all the time. Investigations
were done to find out if there were other treatable causes of high BP. In the
face of such a problem a new treatment has been available for the past two
years as an investigational method but has gradually attained widespread
acceptance in Europe.
One of the
mechanism by which BP is maintained is by the regulation of the diameter of the
blood vessels, particularly of the arteries to important organs such as brain,
liver, intestines and most importantly the kidneys. The kidneys are able to
regulate the formation of urine and the amount of sodium and potassium in the
urine by the feedback mechanism provided by the nerves that populate the
surface of the renal arteries. Finally the BP is maintained at a normal rate.
Renal artery sympatheic innervations and
Radiofrequency ablation (In pic)
In patients
with high BP where despite numerous drugs the BP is difficult to control it was
hypothesized that by removing the effects of these nerves the predominant
effect of trying to maintain a high BP is effectively neutralized . This can
result in fall of BP. We can utilize this response to control BP in our
patients by destroying these nerves. This can be done by radiofrequency energy
which by resistive heating will functionally neutralize the nerves. This was done in our patient by using
conventional radiofrequency energy using very low power at low temperatures and
small duration. The remarkable advantage of this treatment is the absolute lack
of side effects of the treating source the radiofrequency energy which is the
same electromagnetic radiation that is used in communication between our
mobiles and the tower. The procedure has to be done with great care taking to
see that the correct amount of power is used at the correct locations and for
the correct time. With such care complications that can potentially occur with this procedure can be
nullified and good longterm benefits obtained.
For the
patient in question the BP dropped from 164/102 to 146/86 at the end of the
procedure and has since been well controlled with the blood pressure being
normal at 135/80 on 30th June 2012.
Catheter
being withdrawn from distal to proximal at different sites of ablation (In Pic)
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
MD,
MD, DM, FACC, FHRS, FCSI
Chief
Consultant Cardiologist & Electrophysiologist,
Head
and Director, Department of Cardiology,
Global
Health City. Chennai
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