Renal Denervation for Resistant Hypertension 

Renal denervation (RDN) is a minimally invasive procedure to treat resistant hypertension. Although it is not yet widely available, Penn Medicine physicians have extensive history with the technique, having been involved in research since the procedure’s earliest clinical trials.

Debbie Cohen, MD, Director of the Hypertension Program at the Hospital of the University of Pennsylvania, and Taisei Kobayashi, MD, Director of the Cath Lab at the Corporal Michael J. Crescenz Veterans Affairs Medical Center, recently joined the Penn Medicine Physician Interviews podcast (see links below) to discuss RDN, its promise as a procedure, and how it is benefiting patients.

“This is a paradigm-shifting technology that we can now offer patients who have problems controlling their blood pressure,” Dr. Kobayashi says.

Lowering blood pressure with renal denervation

RDN ablates nerves surrounding the renal arteries, which play a role in regulating blood pressure. Ablating those nerves leads to significant reductions in blood pressure in about 75 to 80 percent of patients.

The FDA has approved two devices for RDN: one that affects the nerves via radiofrequency, and the other that achieves the same result via ultrasound. The two approaches have similar safety and outcomes data, and both are approved for any patient who has uncontrolled hypertension, regardless of lifestyle and medication history.

Clinical trials of RDN have found a reduction of about 5 to 10 millimeters of mercury of systolic blood pressure at 2 to 6 months following the procedure. That is on par with the average reduction seen in large placebo-controlled trials of hypertension drugs, Dr. Kobayashi says, noting the benefit of even minor decreases in blood pressure.

“In large observational trials, even a drop as small as 5 millimeters of mercury over the course of a patient’s lifetime can drop cardiovascular mortality by 10 percent,” he adds.

For many patients, blood pressure continues to drop in the years following RDN, with some data suggesting reductions of as much as 17 to 20 millimeters of mercury. “We now have long-term data showing even more impressive results, with maintenance of blood pressure reduction and incremental lowering of blood pressure, as well as excellent safety data,” Dr. Cohen says.

Renal denervation is most appropriate for patients with poor blood pressure control who require three or more drugs and those who have significant medication side effects. It may also be an option for patients who are unable, for any reason, to maintain a medication regimen.

Patients with secondary causes of hypertension, such as primary aldosteronism, do not experience benefits from the procedure, so it’s important to screen candidates.

Comprehensive hypertension care at Penn Medicine

Penn Medicine continues to be involved in research to advance RDN, including post-market trials for approved devices and a trial of a new device that may decrease procedure time. Additionally, many new hypertension drugs are actively being evaluated, including injectable agents, aldosterone synthase inhibitors, and dual endothelin receptor antagonists. “Penn is unique in being able to offer patients access to all of these trials,” Dr. Cohen says.

A team of specialists at Penn Medicine works together to manage patient care and determine the best approach to managing hypertension, whether this involves RDN or another therapy. “One of the things that makes Penn unique is that we’re able to deliver truly comprehensive hypertension care,” Dr. Kobayashi says.

Renal denervation is an important tool in that toolbox, Dr. Kobayashi adds. “This has the possibility to decrease strokes and heart attacks by 10 to 20 percent over a patient’s lifetime,” he says. “We’re standing on a precipice of being able to decrease cardiovascular disease on a population basis.”

Clinical consult and patient referral

Dr. Cohen and Dr. Kobayashi see patients at the Penn Medicine Perelman Center for Advanced Medicine in Philadelphia, PA. For a provider-to-provider consultation, call 215-662-4335, or refer a patient online.