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New Procedure Aims to Lower Treatment-resistant Hypertension

Tocelebrate February as American Heart Month, the News Blog is highlighting someof the latest heart-centric news and stories from all areas of Penn Medicine.

Heart stethescope via stock.xchangeImagine going through life with anextremely elevated blood pressure that cannot be controlled by medication,walking around for months and years with dangerously high risks of blindness,stroke, heart attack or even heart failure.

More than 75 million American adults areliving with hypertension; nearly 1 in 3 adults, according to the CDC.Of that, up to 10 percent, or around 7 million people, have treatment-resistanthypertension, where their blood pressure remains high (over 140/90 mmHg)despite treatment with at least three or more different types of blood pressuremedications (including a diuretic). 

Penn Medicine is the first in the region tobegin testing a newprocedure to help people whose high blood pressure can't be controlledusing currently available medications.  

"Many of our patients have trieddiligently to get their blood pressure under control, through medication andlifestyle changes, to no avail," said Debbie Cohen,MD, co-investigator of the studyat Penn and associate professor of Medicine in the division of Renal,Electrolyte and Hypertension. "So we're trying an approach that makesphysiologic sense in hopes that it will denervate the renal sympathetic nerves and reduce blood pressure."

This procedure, called renal denervation,is being tested by an interdisciplinary team of hypertension and interventionalcardiology experts at Penn. It involves inserting a catheter through an arteryin the groin, which is threaded up to the renal artery, where a specificcatheter using radio frequency energy is used to deactive the renalnerves. It doesn't involve a permanent implant and can be performed underconscious sedation.

"In thisclinical trial, we are studying whether the procedure effectively getthe patients back to their target blood pressure," said RobertL. Wilensky, MD, co-investigator of the study and professor of Medicine inInterventional Cardiology. "We've done a number of procedures at thispoint and are ahead of our recruitment goal, which indicates the real unmetneed for people with complex hypertension."

The approach works to control the activityof nerves going in and out of the kidneys responsible for regulating thesympathetic nervous system, which plugs into the body's system to regulateblood pressure. If the nerves are overactive, hypertension can ensue.

The procedure is still being tested in a clinicaltrial, and is only being used in controlled research studies. Penn isactively recruiting at least 15 patients for the study and is on track to reach enrollment goalsaround June; results should be available a few months later. The procedure isalready approved and available in Europe, Australia and New Zealand.

If the results of the current study provepositive, researchers anticipate that renal denervation may become an importantapproach to treatment for patients with difficult to control high bloodpressure.

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