In a new study from Columbia University, researchers found that brief pulses of ultrasound delivered to nerves near the kidney produced an effective drop in blood pressure in people whose hypertension did not respond to medications.
In the procedure, called renal denervation, daytime blood pressure after two months had dropped 8 points compared to a 3-point drop in patients who were not treated with the procedure.
Nighttime blood pressure decreased by an average of 8.3 points in the treatment group versus 1.8 points in the control group.
These results suggest that renal denervation has the potential to become an important add-on to medication therapy.
About two-thirds of people who take medications to lower blood pressure are able to control their condition. But in others, the drugs do not work or people do not take them as directed.
The kidney plays a role in blood pressure by controlling how much water is in the bloodstream (more water = more pressure) and acting as a central signaling center for other systems that regulate blood pressure.
Renal denervation, a minimally invasive procedure, uses ultrasound energy to disrupt signals from overactive nerves in the renal arteries. The therapy is delivered via a catheter that is threaded through an artery in the leg.
Targeting these nerves is not a new idea in hypertension treatment; several existing medications reduce renal nerve activity to reduce blood pressure.
In this study, the researchers tested the effectiveness and safety of a device that delivers two to three short blasts of ultrasound to nerve fibers that travel close to the renal artery.
The study included adults with moderate to severe hypertension despite taking three or more antihypertensive drugs. All of the patients were switched to the same medication regimen for their hypertension.
Of 136 patients whose blood pressure remained high after four weeks on the new regimen, 69 were treated with renal denervation and 67 had the control procedure.
The team says for patients with drug-resistant hypertension, a drop in blood pressure of 8 points—if maintained over longer-term follow-up—is almost certainly going to help reduce the risk of heart attack, stroke, and other adverse cardiac events
The treatment is still experimental, has not been approved for use by the FDA, and is only available through clinical trials. The trial will follow patients for five years to determine if the drop in blood pressure is maintained over time.
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The study is published in The Lancet. One author of the study is Ajay Kirtane, MD.
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