Modern antihypertensive pharmacological interventions have improved the control of hypertension, but an estimated 30% of hypertension cases are resistant. Resistant hypertension is defined as blood pressure above target (140/90mm Hg) despite concomitant use of 3 or more anti-hypertensives – one of which should be a diuretic.
In subjects with resistant hypertension, the sympathetic nervous activation to the kidney and the sensory afferent signals to the central nervous system are over expressed. In these patients renal denervation should be a valid option. Renal denervation is a minimally invasive procedure that utilizing a percutaneous system that delivers radiofrequency energy through the luminal surface of the renal artery aimed at treating resistant hypertension.
By applying radiofrequency pulses to the renal arteries, the nerves in the vascular wall (adventitia layer) can be denervated. This causes reduction of renal sympathetic afferent and efferent activity and blood pressure can be decreased. Early data from international clinical trials is promising demonstrating average blood pressure reduction of approximately 30mm Hg at three year follow up in patients with treatment-resistant hypertension. Since 2007 over 4000 patients have undergone catheter based renal denervation with the Medtronic Symplicity™ Renal Denervation System and now other systems like Boston Scientific and Covidien system are even simpler and safer than the first one. Our hospital have the facilities to use all these systems.
Renal Artery Ablation for resistant hypertension
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