30 March 2011

Nerve treatment may ease high blood pressure

A technique that interrupts nerve signals between the kidneys and brain dropped blood pressure to normal levels in 39% of patients with drug-resistant hypertension, according to a study.


A technique that interrupts nerve signals between the kidneys and brain dropped blood pressure to normal levels in 39% of patients with drug-resistant hypertension, according to a small new study led by French researchers.

At 24 international sites, 106 patients with uncontrolled high blood pressure (hypertension) randomly received either oral medication or renal denervation treatment, a procedure that uses a catheter-based probe emitting high-frequency energy near the renal artery to deactivate nearby nerves. It was the first human randomised trial of its type, with US experts hailing the results as exciting and "visionary."

Six months later, the patients who received the nerve block procedure had experienced an average systolic blood pressure drop of 32 mm Hg and a diastolic blood pressure drop of 12 mm Hg, the study authors said.

Half of the nerve block patients showed a measurable benefit, and 39% reached recommended blood pressure levels, said study author Dr Marc Sapoval, professor of clinical radiology and chair of the cardiovascular radiology department at Hopital Europeen Georges-Pompidou in Paris.

The procedure also appeared safe, with a low incidence of local complications, researchers reported.

Research still experimental, but promising

Prior to the study, all the participants had had resistant essential hypertension, which means that a doctor could not figure out what was causing their high blood pressure (a systolic blood pressure of 160 mm Hg or more, or 150 mm Hg in people with type 2 diabetes) and that three or more drugs had failed to control the condition.

While encouraged by the results, Sapoval noted that the research was funded by manufacturers of the catheters and generators used in the study, and that the study was small, cautioning that more and larger independent trials and patient follow-up should be done. According to background materials accompanying the study, the US Food and Drug Administration is planning a trial of the procedure involving more than 100 US-based interventional radiology teams.

Sapoval also stressed that the research is still experimental and that the procedure should only be done by interventional radiologists on carefully screened patients in controlled research and academic settings.

"If the results are confirmed, it will be a frequent procedure," Sapoval said. "If further trials show that patients with less severe hypertension can benefit also, the number of patients will be huge."

Why renal denervation works is not entirely clear, Sapoval said, but it appears to dampen overactivity of the sympathetic nervous system, which can trigger high blood pressure.

May become outpatient procedure

Dr Kirk Garratt, clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City, said, "If this technique works, I believe it will be used first in patients with very, very difficult blood pressure issues," Garratt said. "Blood pressure trouble is extraordinarily common, and the cumulative cost measured by the cost of medications alone is very substantial. But poor control drives up the cost of health care overall."

Described as minimally invasive, renal denervation may be an outpatient procedure if it becomes commonplace, which could happen in several years, Garratt said.

"It's a very novel and advanced technique, but the technical aspect would be familiar and easily adopted," he said.

Dr Barry Cohen, medical director of the catheter laboratory at Gagnon Cardiovascular Institute at Morristown Memorial Hospital in New Jersey, called the study participants' blood pressure reduction "really unbelievable," and hopes the treatment could decrease the risk of cardiovascular and kidney problems arising from high blood pressure.

When promising research such as this is reported, "we think it's a shoe that's going to fit every foot, but we know we always have to be cautious and there may be some pitfalls. I think this is extremely visionary and . . . groundbreaking," Cohen said.

(Copyright © 2010 HealthDay. All rights reserved.)


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Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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