Team McCallum

R&D for Lifetime of Life

New(?) treatment for HBP.

An updated form of an old treatment for resistant high blood pressure (HBP) has been found to be succesful in a trial conducted in 24 centres around the world.

Dr Murray D Esler reported the findings at an AHA meeting in Chicago, with simultaneous publication in the Lancet.

Around 15% to 20% of people with HBP do not respond to treatment, despite being treated with 3 different drugs for this. Dr Esler’s study recruited only those resistant to medicine, and most of the patients in the trial were taking 5 drugs for blood pressure control.

The new/old treatment is renal denervation. Before modern medicines displaced it, this was performed by surgery, to cut certain nerves attached to the kidneys (those involved in the part of the nervous system called the sympathetic nervous system). The new format for drug-resistant HBP involves passing a catheter through an artery and ‘cutting’ the nerves using high-frequency radio waves.

The fact that the 100 or so patients were treated in 24 separate centres world-wide means that the procedure is easy and safe.

Those treated with renal denervation continued their medication, and were compared to a control group on medication only. On average there was no change in blood pressure for the control group.

Those on renal denervation dropped from an average of 178/96mm at the start to an average of 146/84mm 6 months after the procedure. Dr Esler told the AHA meeting that the drop was rapid after the denervation, and appeared to cause blood pressure to drift slightly lower when follwed up over two and a half years, suggesting that the improvement is permanent.

One potential query is that only a small percentage of the patients (17%) were on aldosterone, a medicine that rebalances sodium and potassium levels to regulate blood pressure. Thus it may be that the patients don’t fit the medically accepted definition of ‘treatment-resistant’.

The procedure is to enter clinical practice in Europe and Australia, while a further trial is to be conducted in the US next year. More trials are also in the pipeline for milder forms of HBP and for other types of kidney problems.

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November 18, 2010 - Posted by | Ablation, Health, High blood pressure

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