When blood pressure can't be controlled with lifestyle and medication, renal denervation may help. This minimally invasive catheterization procedure helps people with difficult-to-treat high blood pressure, also known as resistant hypertension, by quieting overactive nerves in the kidneys that play a critical role in regulating blood pressure.
“At Duke, we have been doing renal denervation for a long time,” said Duke Health interventional cardiologist Manesh Patel, MD. “We have the skill and the will to make people healthier in all the ways that it takes.”
When Hypertension Starts in the Kidneys
Blood pressure measures the force of blood pushing against your artery walls. It’s critical to keep your blood pressure in check, because blood pressure that is too high (hypertension) increases your risk of stroke, heart attack, organ damage, dementia, and other health problems. Diet, exercise, and medications can help lower blood pressure, and sometimes more than one medicine is needed. Resistant hypertension refers to blood pressure that doesn't respond to lifestyle changes and medications alone.
The kidneys are a major driver of blood pressure in people with resistant hypertension. That’s due to misfiring renal nerves, which connect the kidneys to the sympathetic nervous system, prompting the kidneys to release hormones that activate your body’s “fight or flight” response. Most hypertension medications block those hormones. However, some people with hypertension cannot get relief from lifestyle changes and medications alone.
Sharon Davis, 75, is one of those people. A grandmother who raises cattle with her husband in Galax, VA, Davis had always been active until episodes of high blood pressure kept landing her in the emergency room, sometimes more than once a week. She was afraid to travel too far from home, in case she needed medical care fast. Eventually, Davis’s local doctors said there was nothing more they could do. “That’s when I called my cardiologist and asked, ‘Could you please send me to Duke?’ And I’m so glad I did,” Davis said.
Identifying the Right Candidates for Renal Denervation
Duke has participated in renal denervation research since 2012, including studies that led to its FDA approval. According to Dr. Patel, who routinely performs renal denervation procedures, the best candidates are people whose blood pressure remains high:
- Despite taking three or more blood pressure medications
- After trying a variety of medication types and doses
- After ruling out other potential causes, like sleep apnea, renal artery stenosis, fibromuscular dysplasia, or hormonal disorders
Renal Denervation: What to Expect
During the renal denervation procedure, an interventional cardiologist makes a small incision in your groin to access a large artery, and then threads a thin tube called a catheter to your kidney arteries. Energy waves are applied to inhibit problematic renal nerve signals in both kidneys. Then the catheter is removed and pressure is held to the small puncture site to ensure there is no bleeding. Most people go home the same day. Davis was back home in Virginia before bedtime.
Life After Renal Denervation
Like Davis, people who undergo renal denervation will have one or two follow-up appointments over the next year. Since Davis’s blood pressure has remained stable, her care team has eliminated one of her medications and reduced another. With her blood pressure now under control, Davis is looking forward to a Florida vacation with her family this summer.
Seek Advanced Care for Hypertension
Hypertension is a major risk factor for many serious medical conditions. At Duke, a team of experts works together to identify the source of your high blood pressure and find ways to reduce it.
“We're trying to make sure there's no stone left unturned when it comes to hypertension,” Dr. Patel said. “It's not always going to get solved with renal denervation, but in this scenario, I’m glad we were able to help Mrs. Davis.”
