Hypertension is the medical term for high blood pressure and is used by doctors when your blood pressure is consistently above normal or optimum levels, usually when your systolic blood pressure is above 140 mmHg and your diastolic blood pressure is above 90 mmHg.
When left untreated, hypertension can lead to health complications, such as heart attack or stroke, heart or kidney failure, problems with eyesight or vascular dementia.
There are three options depending on you and severity of your condition:
Making positive changes to your lifestyle, such as improving your diet, can help with hypertension control.
If lifestyle changes alone are not enough, your GP may prescribe medications that work together to bring your blood pressure down.
If you are showing signs of resistant hypertension or are unable to tolerate medications, then a renal denervation procedure may be appropriate.
Based at The Manor Hospital, the Oxford RDN Service specialises in treating patients with resistant hypertension – including those who find medications ineffective and those who can’t tolerate medications. Staffed by interventional cardiologists who are experts in their fields, the Service performs renal denervation procedures for insured and self-pay patients.
The first step is for a hypertension review with a cardiologist to determine the best course of treatment for you.
Dr Giovanni L. De Maria is a consultant cardiologist with a special interest in Interventional Cardiology. He has been working within the Oxford University Hospitals NHS Foundation Trust for almost 10 years.
He is actively involved in both patients’ care and clinical research, with his main research interests spanning from novel/additional therapies for heart attack (STEMI), coronary physiology and intravascular imaging as guidance to optimise revascularisation procedure, and renal denervation for treating patients with resistant hypertension.
Professor Banning has been the senior Interventional Cardiologist at the Oxford John Radcliffe Hospital since 1999.
During his career, Professor Banning has focused on non-invasive cardiac techniques, including the pioneering TAVI treatment for aortic stenosis. He was also an early advocate of ‘drug eluting stents’ as an alternative to the coronary bypass. He has also been President of the British Cardiac Intervention Society.
Generally, RDN is suitable for those who have uncontrolled medium to high hypertension and are already on several types of medications, or have experienced side effects from most blood-pressure medications. Your GP or consultant cardiologist will help you decide whether this procedure is right for you.
The aim of renal denervation is not discontinuing the tablets, but to ensure optimal blood pressure control, as this is what drives a reduction in the risk of stroke or heart attack.
There is however a good chance that the dose or number of tablets might be decreased after the procedure. However, the procedure is considered a success even when a patient, who had initially poor blood pressure control on medications, achieves optimal blood pressure values afterwards, even though this requires taking all or some of the initial medications.
An extra benefit, possibly associated with the procedure, is that the effect on blood pressure is always ON when compared to medications that have an effect on blood pressure only when the patient remembers to take his/her tablets.
Some people can go home the same day of the procedure, some may need an overnight stay.
Usually about a week, after which many people return to their normal activities. Your doctor will monitor you and let you know when you are ready.
Generally, you may have two follow-up appointments; one with the consultant who performed your procedure, and one with your GP.
Renal denervation has a well demonstrated safety-profile. However as in any invasive test/procedure, complications can occur. The cardiologist performing the procedure, or your GP, can discuss this in more detail.
Injury to the kidney or narrowing of the renal artery are possible serious complications, though extremely rare with an incidence reported in clinical studies below 0.5%.
The most common side effect associated with renal denervation is bleeding at the entry site (groin) where the puncture is made to insert the catheter to perform the procedure. In clinical studies no major bleeding complications have been described.
The occurrence of bruising/haemathoma at the entry point though is not uncommon. This can sometimes be source of discomfort for a few days/weeks after the intervention, but it usually responds well to painkillers and tends to resolve spontaneously over time.
This is variable according to the vessels’ anatomy, but an average procedure can take around 60 minutes.
The procedure can be painful at the stage when energy is delivered to disconnect the nervous fibres. For this reason, it is performed under local anaesthesia, analgesia, and deep sedation, meaning that the patient is usually not awake during the procedure, but still able to breathe spontaneously without need of assistance of specific medical equipment. The level of awareness during the procedure can vary from individual to individual, with most patients typically sleeping throughout; though there are rare scenarios when some degree of vigilance remains.
The short answer is no, as the procedure aims at reprogramming the connections between the brain and the kidney and this cannot happen immediately. Roughly, the effect of the procedure becomes manifest between 3 and 6 months, even though there have been cases with quite immediate response after a few days.
Please keep in mind, like for any therapy, there is roughly a 20% chance of absence of response. Unfortunately, we currently cannot predict ahead of time who will be and who won’t be a good responder to this treatment.
According to the available data, the effect on blood pressure seems to be well maintained over time and well reflected by the observation that nerves around renal arteries do not regrow. The most solid data confirmed a maintained lowering blood pressure effect at least up to 3 years, but data supporting maintained effect on blood pressure beyond 3 years are growing.