Generally, if you begin treatment for your hypertension, the target blood pressure will be less than 140/80 mmHg. Recent guidelines suggest that whenever possible, and if tolerated, an attempt should be made to achieve a systolic blood pressure between 120 and 130 mmHg if you are below age 65. This is especially the case in the presence of concomitant conditions such as diabetes, past history of heart disease, or stroke.
Your GP will prescribe hypertension medication if your blood pressure is regularly above 160/100 mmHg. You are also likely to be prescribed medication if your blood pressure is above 140/90 mmHg and you have high risk factors for cardiovascular disease (i.e., heart attack, stroke, or renal function impairment), or if you are at moderate risk but your blood pressure is still uncontrolled after six months of attempting to optimise your lifestyle.
In addition to taking medication, you will be advised to try to stick with lifestyle changes to help keep your hypertension under control.
Many people take more than one type of medicine, and your age, ethnicity and whether you have other conditions, such as diabetes, will affect which medication you are prescribed.
Your GP will know which drugs are best for you. But here’s an overview of the five main types of medications, how they work and why they are chosen.
These agents inactivate a hormone released by your kidneys and as a result they reduce your blood pressure by aiding your kidneys in expelling water and by relaxing your blood vessels. You are likely to be prescribed an ACE inhibitor if you are under 55 or have type 2 diabetes.
These work in a similar way to ACE-inhibitors and again, are best for people under 55 or those with type 2 diabetes. They can be prescribed as first line or as an alternative in case you experience side effects with ACE inhibitors – most commonly a dry cough.
These reduce the pressure in your blood vessels by widening them. They are commonly prescribed for those aged 55 or older, or if you’re of African or Caribbean origin (if you don’t have type 2 diabetes).
These types of medication flush excess water and salts from your body in your urine and are prescribed instead of calcium channel blockers if they have caused side effects, or if you have had signs or heart failure.
These can reduce blood pressure by reducing your heart rate and making your heart beat more gently. They are not typically as effective as other medications, but your doctor may prescribe them in combination with other medications or whenever other medications haven’t worked.
These medications are often used in combination, and recent guidelines suggest a more aggressive approach, with a combination of at least two agents when starting a medication-based treatment plan for suboptimal blood pressure control.
Most people with hypertension find that they respond to medication without any problems. However, for some, things are not so straightforward.
Simply remembering to take your medication at the same time each day can be difficult, especially if you are very busy or have to remember to take several different medications at different times.
Not everyone gets side effects, many people take hypertension medication for decades without any problems. But side effects can occur, and if they are persistent or severe, such as bad headaches or extreme tiredness, they can make finding the right medication difficult.
It could be that your body is simply not responding to the medication, despite adhering to your medication plan.
Hypertension is diagnosed when your systolic blood pressure is above 140 mmHg, and your diastolic blood pressure is above 90 mmHg (i.e., 140/90). Any treatment you undergo will aim to bring your blood pressure values below this threshold, and ideally achieve a systolic blood pressure between 120 and 130 mmHg. This is especially important if you have diabetes, history of heart disease, or have suffered a stroke.
There are three main treatments available for bringing your hypertension under control:
For mild hypertension with no other risk factors, making lifestyle changes may be enough.
For moderate to severe hypertension, or mild with other risk factors, you may need a combination of medications.
For resistant hypertension or intolerance to medications, you may benefit from a renal denervation procedure.
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.