Hypertension/Renal nerve denervation
Hi Dr. Falkinburg,
I saw my EP today and he suggested a renal nerve denervation. The last time i posted a question i told you my BP is pretty much stuck at 160/100 (highs over200/115; lows in the 150s/95) most of the time. My cardiologist upped the dose of Micardis to 80/day but it hasn't really done much to lower the numbers. Is renal nerve denervation something to pursue or is it still too early in the procedure to take the chance.
Good afternoon, Andey,
Renal nerve denervation is a new procedure that has shown to be quite effective for the treatment of RESISTANT HYPERTENSION.
Resistant hypertension is defined as poorly controlled blood pressure in a compliant patient, who does NOT abuse alcohol, who is taking three different antihypertensive medications (that have different mechanisms of action), one (medication) of which is a diuretic (such as chlorthalidone). Some would add that an additional medication such as sprinolactone (aldactone is the trade name) or epleronone be used as a fourth medication as well. If this regimen is unsuccessful in controlling the BP, then consideration of renal nerve denervation is appropriate.
It goes without saying that all secondary causes of hypertension must be ruled out. These would include chronic kidney disease, pheochromocytoma, aldosteronoma, Cushings syndrome, coarctation of the aorta, renal artery stenosis, Liddle's syndrome, alcoholic abuse and any others that I might have forgotten off the top of my head.
Personally, I would NOT have this procedure done in the community but would ask for a university referral to have my BP evaluation and treatment reviewed, first. Then, if they felt it were indicated, I would have it done there by someone who has done many of them. It is still new and someone in practice is UNLIKELY to have done a sufficient number of the procedures, at this point in time, to be proficient.
That's my take.
It's good to hear from you again and I'm sorry that you are still having trouble.
It sounds like your thinking is clear though.
I'd appreciate it if you would keep in tough and let me know how things work out.