Renal denervation: A novel treatment for hypertension
A groundbreaking new treatment for resistant hypertension is gaining traction as a one-time, long-term solution to effectively lower blood pressure without medication — ultimately lowering the risk for conditions like heart attack, stroke and kidney damage.
Earlier this year, Merrill Krolick, DO, an interventional cardiologist with HCA Florida Healthcare, introduced renal denervation (RDN) as a promising option for certain patients struggling with hypertension.
What is renal denervation?
Renal denervation is a minimally invasive procedure designed to treat resistant hypertension, or high blood pressure, that hasn’t improved with other treatments.
The procedure earned clearance as an FDA-approved treatment for high blood pressure in 2023. This January, the Centers for Medicare & Medicaid Services (CMS) approved it for Medicare use. That’s when Dr. Krolick and his team began offering renal denervation as an option to patients who qualify.
HCA Florida Healthcare is one of only a handful of healthcare networks nationwide to offer this leading-edge intervention.
The case for “something different”
Traditionally, hypertension treatment options include lifestyle changes like eating a diet with less salt and, if necessary, medication. If you need medication, taking the medication as prescribed is critical. Yet that’s the problem many patients face, Dr. Krolick says.
“In many cases, patients can’t afford the high costs of some of these blood pressure medications, so they’re not taking them,” he notes, adding, “In my role as an interventionalist, I’m particularly interested in hypertension because it’s one of the risk factors of heart disease. Most patients I see in my office don’t have blood pressures in the goal range, and some of them are on multiple medications. I thought we needed something different.”
High blood pressure in the United States
According to the American Heart Association (AHA), blood pressure is considered high when it measures 130/80 or above. That’s systolic pressure over diastolic pressure. Systolic, the top number, is the measure of the pressure in your arteries when your heart beats. Diastolic, the bottom number, is the measure of the pressure in your arteries between heartbeats, when your heart is relaxed.
Risk factors of high blood pressure include things like older age, family history, and being overweight or obese. But risk can also increase due to lifestyle factors like lack of exercise, eating too much salt, drinking too much alcohol and having low potassium levels.
Hypertension is often called a “silent killer” because it usually has no noticeable signs or symptoms. The U.S. Food & Drug Administration reports that only about 1 in 4 of the more than 119 million U.S. adults who have high blood pressure, which is almost half of the population, have their high blood pressure under control. Because high blood pressure often goes unnoticed, routine screenings are the most effective way to detect and manage it before serious health issues develop.
Yet hypertension is one of the leading causes of death in the U.S. That’s due to its link to serious conditions like heart disease and stroke.
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Kidney function and hypertension
One of the serious dangers of high blood pressure is organ damage, particularly kidney failure.
According to the AHA, uncontrolled high blood pressure can cause arteries in and around the kidneys to narrow, weaken or harden over time. When this happens, the kidneys don’t receive the oxygen and nutrients they need to filter waste from the blood, one of their main functions. They also can’t regulate fluids, hormones, acids and salts. Additionally, excess fluid in the bloodstream further elevates blood pressure, creating a dangerous cycle that can lead to kidney failure.
“I get a lot of consultations from nephrology because, if you look at what happens with poorly controlled hypertension, it’s kidney failure, which leads to a referral for a kidney transplant,” Dr. Krolick says.
The National Institute of Diabetes and Digestive and Kidney Diseases reports that high blood pressure is the second leading cause of kidney failure in the United States, after diabetes.
Renal denervation: an innovative hypertension treatment
Renal denervation helps patients lower their blood pressure without additional medication.
The interventional approach takes about an hour and is typically performed as an outpatient procedure. Using a catheter, an interventional cardiologist delivers heat energy to the renal arteries, destroying overactive nerves near the kidneys that contribute to high blood pressure while sparing damage to the arteries. This reduction in nerve activity leads to a sustained drop in blood pressure.
“This new treatment can help minimize the stress on patients’ kidney function, and we can also consider decreasing the amount of hypertensive medications that have been linked to potential long-term kidney damage,” Dr. Krolick says.
Candidates for renal denervation
Renal denervation may be an option for people with hypertension whose high blood pressure levels don’t respond to lifestyle changes or blood pressure medications. Typically, Dr. Krolick says, the procedure is recommended for people who are on at least three medications to control high blood pressure.
For now, renal denervation is not approved for people who are on dialysis or for those with severely impaired kidney function.
Benefits of renal denervation
Renal denervation provides numerous benefits for people with resistant hypertension, Dr. Krolick says, adding that, in his experience, around 85% of patients respond to the treatment.
Patients experience lower blood pressure and a reduced risk of heart failure, stroke and kidney disease. For many, it also significantly reduces their blood pressure medication dosage, or allows them to stop taking some of their medications altogether.
“I tell patients it will eliminate one or more of their medicines,” Dr. Krolick says.
Because the patient’s blood pressure doesn’t drop right away after renal denervation — it usually takes a month to six weeks to see a dramatic lowering — Dr. Krolick says he removes one blood pressure medication from a patient’s regimen at a time, and waits until their follow-up appointment to start.
“When so many are coming to me on five or 10 blood pressure medications, economically speaking, even eliminating one or two blood pressure medications for someone on a fixed income is a big deal,” he notes.
Beyond blood pressure control, the American College of Cardiology highlights additional benefits, such as improvements in sleep apnea.
Patients also tend to feel better overall after undergoing the procedure, Dr. Krolick says.
“So far, the results have been outstanding,” he says. “Patients maintain this lowered blood pressure for years afterward, but, more importantly, they have a lower risk for developing events like heart attack, heart failure and angina (chest pain that’s a common symptom of heart disease).”
Dr. Krolick adds: “This is about quality of life and lowering someone’s risk over many years.”
Risks of renal denervation
Renal denervation is considered “pretty risk-free,” Dr. Krolick says, although, as with any interventional procedure that accesses the vascular arteries, there is a small possibility of infection.
Rare risk of complications include:
- A hole or tear in the renal arteries
- Embolism (a blockage in a blood vessel usually caused by a blood clot)
- Heart rhythm disruptions, including bradycardia (a slowed heart rate)
Choose experience
Because renal denervation is a specialized procedure, it should be performed by a highly trained specialist with extensive experience, Dr. Krolick says.
“To perform a renal denervation procedure,” he adds, “you have to have a certain skill set and take your time to ensure you’re doing it correctly.”
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