Renovascular Denervation

Introduction

Institut Jantung Negara (National Heart Insitute) Kuala Lumpur is currently initiating and offering a cathether based renal symphatetic denervation for suitable patients with resistant hypertension.

Resistant hypertension

High blood pressure or Hypertension is a common disorder and affect at least 30 to 40% of the adult population in the developed world. Most patients who suffer from hypertension do not have any symptoms. However many studies have shown higher blood pressure is associated with increased risk of ischaemic heart disease and stroke. A study by MOH, J.p et al showwed that lowering blood pressure by as little as 5mmHg can reduce the risk of stroke by almost 30%.

The science behind renal denervation?

Resistant hypertension is defined as systolic blood pressure of more than 160 mmHg (more than 150mmHg for the diabetic patient) despite being on 3 or more antihypertensive medications.

The treatment of hypertension remains a big challenge despite the availability of many different classes of pharmacological therapies.  The suboptimal blood pressure control can be attributed to multiple factors. These include non compliance to medications and poor tolerance due to medication side effects. It is difficult being on lifelong, multiple medications for a condition that is mainly asymptomatic.

The renal sympathetic nerve that innervates the wall of the renal artery is important in the pathology of hypertension.  It regulates the sodium retention, stimulation of the renin release and reduction of the renal blood flow. The hyperactivation of these factors lead to hypertension.  Studies have shown that inhibiting the sympathetic nerve via surgical means will lower the blood pressure.  The SYMPLICITY HYPERTENSION TRIAL has shown that renal denervation is a safe procedure that causes blood pressure reduction in patients with resistant hypertension.

The renal denervation procedure is relatively new. However, this could be a breakthrough procedure that offers hope to those patients with resistant hypertension to achieve optimum blood pressure control