High blood pressure is the most prevalent cardiovascular risk factor in the world. Only in Spain, as highlighted by Dr. Jorge Moisés, specialist in Nephrology and co-director of the Institute of Cardiology and Internal Medicine (CMI) of the Teknon Medical Center in Barcelona, it is estimated that 42.6% of the adult population over 18 years of age is hypertensive.
Despite pharmacological treatments, a notable percentage of patients do not achieve adequate control. Thus, this expert highlights, renal denervation once again offers hope to patients who struggle to control their blood pressure and cannot achieve it pharmacologically.
Dr. Moisés states that “kidney denervation has been revalued as a safe approach with effective results, which is why Teknon Medical Center has launched this type of therapy. “It is a minimally invasive intervention that involves blocking the renal sympathetic nerves, using an endovascular catheter approach.”
A day of intervention
The specialist emphasizes that the possibility of complications is “really low and exceptional” and, among other points, he emphasizes that it does not require general anesthesia, but that sedation of the patient is sufficient. “When performed percutaneously, a rapid recovery is also possible, and in just one day the patient returns home and rejoins their usual daily life,” he points out.
Of course, as he emphasizes, for the good management of hypertension and renal denervation, it must be complemented with lifestyle changes, such as a healthy low-sodium diet, with the practice of regular physical activity and with the reduction of stress, as well as as with the appropriate use of antihypertensive drugs.
"But it is true that renal denervation is presented as an additional and promising option for those patients who cannot control their blood pressure despite conventional treatments," says Dr. Moisés, who highlights the importance of adequate screening, in which that underlying causes that may explain the condition of hypertension are ruled out.
Renal denervation seeks to reduce the activity of the renal sympathetic nervous system, which plays a fundamental role in the control of blood pressure, and is performed in the Multidisciplinary Hypertension and Renal Denervation Unit, the result of collaboration between the Teknon Heart Institute and the Institute of Cardiology and Internal Medicine (CMI).
Catheter through the femoral artery
Dr. Moisés explains, among other points, that it is a safe procedure that is performed percutaneously: “It is performed using a catheter that is inserted through the femoral artery, to reach the renal arteries from there. Once placed in position, a radiofrequency is applied that generates thermal energy, capable of destroying the sympathetic nerve endings in the area.”
In this way, adds Dr. Juli Carballo, interventional cardiologist and head of Cardiology at the Teknon Heart Institute, it is possible to reduce the activity of the renal sympathetic nervous system, which plays a fundamental role in the control of blood pressure, since it is responsible for to stimulate it. “By lowering it, this technique is expected to contribute to a significant reduction in blood pressure,” he adds.
On the other hand, and although this procedure has been known for years, Dr. Jorge Moisés, specialist in Nephrology and co-director of the Institute of Cardiology and Internal Medicine (CMI), maintains that some studies whose methodology was questioned called it into question, But more recent research has shown that “it is a safe and effective procedure to help manage patients with resistant hypertension who currently had no options.”
In this context, this expert from the Teknon Medical Center appreciates that, recently, the updated guidelines of the European Society of Hypertension have highlighted the role of renal denervation as a third pillar in the hypertension care pathway, reinforcing its position in the treatment of resistant hypertension. “This clinical guideline reinforces the safety and effectiveness of this technique and highlights the importance of a multidisciplinary approach,” he clarifies.
At the same time, remember that in 2022 a joint positioning document was published by the Spanish Society of Hypertension-Spanish League for the Fight against Arterial Hypertension (SEH-LELHA), and the Association of Interventional Cardiology of the Spanish Society of Cardiology ( ACI-SEC), where the available evidence on the efficacy and safety of renal denervation in the treatment of hypertension was reviewed, supporting the treatment.
“Initial studies showed promising results, but the controversial results of the SYMPLICITY HTN-3 trial led to the abandonment of the technique. In the last three years, the results of new clinical trials have appeared, with new devices and in different populations, which definitively demonstrate the effectiveness of renal denervation," states the aforementioned consensus document.
However, Dr. Carballo reiterates the need for this technique to be implemented by medical professionals trained and experienced in the procedure. “While the results so far have been encouraging, it is essential to continue researching and collecting data to fully evaluate its long-term efficacy and safety. With a comprehensive and collaborative approach, we can move towards better management of hypertension and improve the quality of life of those living with this chronic condition,” concludes Dr. Moisés.
