A New Era In Hypertension Treatment: Renal Denervation Offers Hope For Millions

Arya Rakshita Sep 29, 2024

A report by WHO reveals that only 54 per cent of adults with hypertension are diagnosed, 42 per cent receive treatment, and a concerning 21 per cent manage to control their hypertension

The World Health Organization's (WHO) first global report on hypertension highlights an urgent need to tackle the growing global burden of this condition. The report reveals that only 54 per cent of adults with hypertension are diagnosed, 42 per cent receive treatment, and a concerning 21 per cent manage to control their hypertension. These statistics underscore the critical importance of improving awareness, diagnosis, and management to reduce the global impact of cardiovascular diseases.

Hypertension, commonly known as high blood pressure, is a silent but serious health issue that affects millions, including a growing number of people in India. When left uncontrolled, it can lead to severe complications, such as heart disease, strokes, and organ damage. Lifestyle changes and urbanisation have also led to a rise in hypertension among younger individuals, making early detection and effective management more essential than ever. Dr. Sarita Rao, Senior Interventional Cardiologist at Apollo Hospitals Indore in an exclusive conversation with the BW Healthcare World discussed the importance of proactive blood pressure monitoring and introduced a groundbreaking treatment option for patients with resistant hypertension—Renal Denervation (RDN) therapy.

Excerpts:

What are some signs to watch for early detection of uncontrolled hypertension in India?

Uncontrolled hypertension means that you have a blood pressure above 140/90 mm Hg. High blood pressure causes damage over time and can lead to cardiovascular diseases and strokes. Your hypertension may be classified as uncontrolled if it's not being treated or if medications that are supposed to help lower your blood pressure have been ineffective so far. Very often, because patients don’t feel the need to get their blood pressure checked proactively without symptoms, hypertension gets out of control and often results in target organ damage. This mainly stems from poor control of hypertension. Only half of the patients who have high blood pressure end up getting treated for it simply because a majority don’t know they even have it. Out of those who get treated for it, only half have control. We are looking at an actual control level of just 20-30 per cent. For those who have uncontrolled hypertension, it affects the major organs of their body including the heart, brain, eyesight and kidneys. We are also increasingly seeing younger people get impacted by hypertension these days, primarily due to lifestyle choices and ‘urbanisation’ that moves them towards poor eating habits like junk or processed food while lowering activeness.

High blood pressure does not get recognised easily as it doesn’t come with any major signs or symptoms. Fatigue and headaches have become an accepted part of our present lifestyle and don’t necessarily raise any alarms from us, though they are signs of high BP. Hence, the first advice is as simple as to get your blood pressure checked proactively, irrespective of your age. This basic monitoring-led intervention can save you from prolonged medical treatments later in life. If you have high blood pressure, your healthcare provider will conduct some follow-up tests to identify whether you have primary hypertension, resulting from a variety of environmental or genetic causes; or secondary to renal, vascular, and endocrine causes. 90% of patients have primary hypertension; it’s very easy to diagnose provided the individual gets their BP monitored frequently.

Are minimally invasive procedures for blood pressure control available in India?

Resistant hypertension is a subset of uncontrolled hypertension, where the patient is on 3 or more BP medications but is still not able to control their hypertension. This is where there has been a groundbreaking intervention in cardiovascular medicine called Renal Denervation (RDN) therapy, offering hope to millions. RDN is a non-incision pinhole procedure and can be done very easily, like angiography. By targeting the nerves in the renal arteries responsible for excessive sympathetic activity, we can effectively lower blood pressure levels in patients who have not responded adequately to conventional medication. Utilising advanced catheter-based techniques, interventional cardiologists navigate the arterial network to access the renal arteries. Once in position, controlled radiofrequency energy is delivered to selectively disrupt the overactive nerves, thereby reinstating balance to the autonomic nervous system and promoting blood pressure reduction.

This is a newer therapy which was approved in India as recently as April 2024, though we at Apollo conducted one 2 years ago, fully approved on compassionate grounds, for a patient for whom this was the only hope. Despite being on 8 medications, this patient was unable to control his blood pressure, but today is thriving as a result of this therapy. We are very happy to be pioneers of this game-changing therapy and hope to significantly reduce India’s uncontrolled hypertension burden with this.

Can these new procedures help achieve long-term blood pressure control, even with medication?

Renal Denervation (RDN) therapy represents a significant advancement in hypertension management. One of its primary benefits is the potential to reduce the number of antihypertensive medications required by patients. By addressing the neurogenic mechanisms contributing to hypertension, RDN can achieve substantial blood pressure reductions, allowing patients to lower their medication intake or number of medications.

While RDN may not cure hypertension entirely, especially in those with borderline hypertension, it effectively lowers blood pressure in individuals with treatment-resistant hypertension and more severe forms of the condition. The long-term efficacy of RDN therapy and its impact on improved cardiovascular outcomes make it a promising option for sustainable hypertension management.

Future prospects of this procedure

The implications of RDN therapy extend beyond managing hypertension. Research suggests potential applications in treating heart failure, chronic kidney disease, and other cardiovascular conditions influenced by sympathetic overactivity. As ongoing clinical trials continue to explore its therapeutic potential, RDN therapy stands poised to redefine cardiovascular care. By addressing the underlying neurogenic mechanisms of hypertension, RDN therapy promises long-term efficacy and significantly improved cardiovascular outcomes, heralding a new era in hypertension and cardiovascular disease management.