Treating Hypertension With Renal Nerve Ablation


Renal denervation therapy shows promise in treating persistent hypertension

By: 

 Dave Fornell
Diagnostic and Interventional Cardiology


Submitted by Mr Soong CS

For patients with severe hypertension that remains uncontrolled despite medical therapy, radiofrequency (RF) energy can be used in the renal vessels to block nerves involved with the sympathetic nervous system. Researchers believe this has the potential to impact the mechanical and hormonal activities of the kidneys and may eliminate the need for medical therapy.

 Symplicity Catheter System, manufactured by Ardian Inc., delivers RF energy from within the renal artery to block conduction in the surrounding renal nerves. This counteracts chronic activation of the sympathetic nervous system. In addition to blood pressure reduction, this treatment shows promising results for chronic kidney disease, heart failure and metabolic syndrome. The treatment is performed in the cath lab using routine interventional techniques similar to those used in renal stent procedures. The 40-minute treatment is minimally invasive and does not involve a permanent implant.

The Symplicity Catheter System already has CE mark approval in Europe and is in trials in the United States.

Device Effectiveness

An initial study of the device in Australia, the Symplicity I trial, showed promising results. “We saw a drop of 27 mm of mercury and the one-year followup showed the effect on blood pressure was durable,” said Krishna Rocha-Singh, M.D., director of Prairie Vascular Institute, Springfield, Ill. He was involved with Symplicity I and in the planning for the U.S. pivotal trial. He has already used the device in numerous patients. “This treatment may help people who have the worst of the worst disease — who have hypertension that medications just can’t control and who are most likely to suffer from stroke and heart disease.”

Symplicity I showed 89 percent of patients saw their blood pressure drop dramatically. At 12 months, the average decline in systolic blood pressure was 27 points and the decrease in diastolic pressure was 13 points. There was no evidence the procedure harmed vessels or kidney function.

During the European Society of Hypertension meeting this summer, Dr. Markus Schlaich, Neurovascular Hypertension and Kidney Disease Laboratory, Alfred and Baker Hypertension Network, Melbourne, Australia, explained the two-year results of the therapy on the initial cohort of 153 patients. He said there were significant reductions in blood pressure in patients with multidrug-resistant hypertension and the effect has been sustained through at least 24 months. Data also show no significant decline in renal function.

Schlaich added there were no RF treatment-related vascular complications.

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This procedure is available at Putra Specialist Hospital Melaka, anyone interested?