EP131: Controlling Blood Pressure With A Procedure, Renal Artery Denervation

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick is a practicing cardiologist and author dedicated to patient education in heart health, believing that informed patients receive better care. In this episode, he explores renal denervation, a cutting-edge procedure that targets the sympathetic nerves controlling blood pressure around the kidneys. The discussion centers on the recent Spiral HTN trial, which demonstrates promising results for this non-medication approach to treating high blood pressure. Key Takeaways: Renal denervation involves destroying the sympathetic nerves (fight-or-flight nerves) that run along the renal arteries to the kidneys, which contribute to elevated blood pressure regulation. The concept originated in Melbourne in the 1990s when researchers hypothesized that sympathetic nerves controlling the kidneys could be contributing to high blood pressure, leading to the first procedure in 2007. The Simplicity 3 trial, which used a sham control procedure, showed disappointing results with minimal blood pressure reduction differences, effectively halting the technology's advancement for years. The failure of Simplicity 3 was partly attributed to non-standardized catheters and operators with insufficient experience in the technique, rather than the concept being fundamentally flawed. The new Spiral HTN trial used an improved catheter design with a corkscrew curl that allows easier application and nerve destruction without requiring extensive operator expertise. The Spiral HTN trial showed statistically significant results: 24-hour blood pressure reduction of 4 mm Hg systolic and office blood pressure reduction of 6.5 mm Hg systolic compared to sham procedure. The procedure was found to be incredibly safe with zero procedural complications reported in the trial. Blood pressure reductions achieved through this procedure offer approximately a 20% relative risk reduction in cardiovascular events for patients. This technology could reduce medication burden for patients with difficult-to-control hypertension and may improve the natural day-night blood pressure variation pattern. The procedure may primarily benefit patients with recalcitrant (difficult-to-treat) hypertension, and future considerations include cost and potential Medicare reimbursement eligibility.