RENAL DENERVATION FOR HIGH BLOOD PRESSURE
Renal denervation is a minimally invasive, catheter-based procedure for some people whose high blood pressure (hypertension) remains above target despite lifestyle changes and blood pressure medicines, or who are unable to tolerate their medicines. It is used alongside, not instead of, a healthy lifestyle and medication.
What is renal denervation?
The nerves that run along the renal arteries (the arteries supplying the kidneys) help to regulate blood pressure. In some people these nerves are overactive, which contributes to high blood pressure. During renal denervation, a thin catheter is passed into each renal artery and energy (radiofrequency or ultrasound) is delivered through the artery wall to reduce the activity of these nerves. The aim is to lower blood pressure over the following weeks to months.
Who may be suitable?
Renal denervation may be considered for adults who:
- Have high blood pressure that remains uncontrolled despite taking several blood pressure medicines (resistant hypertension)
- Experience side effects that make it difficult to take blood pressure medicines regularly
- Have had secondary (treatable) causes of high blood pressure excluded
- Have suitable kidney function and renal artery anatomy on imaging
Your cardiologist will discuss whether the procedure is appropriate for you, taking into account your overall health, your blood pressure readings and your preferences.
Assessment before the procedure
- Confirming high blood pressure with home readings or 24-hour ambulatory blood pressure monitoring
- Reviewing your current medicines and how they are being taken
- Blood and urine tests, including kidney function
- Tests for secondary causes of high blood pressure, such as hormonal conditions or obstructive sleep apnoea
- Imaging of the renal arteries, usually with a CT or MR scan, to check that they are suitable
What happens during the procedure?
Renal denervation is performed in a cardiac catheterisation laboratory, usually under local anaesthetic with sedation and pain relief. A small tube is placed in an artery in the groin or the wrist, and a catheter is guided to the renal arteries using X-ray imaging. Energy is then delivered at several points along each renal artery. No implant is left in the body. The procedure typically takes one to two hours, and most patients go home the same day or the following day.
After the procedure
Most people return to normal activities within a few days. You will be advised to avoid heavy lifting for a short period while the access site heals. Blood pressure usually falls gradually, so you will continue your medicines and attend regular follow-up to review your readings. Your medicines may be adjusted over time, although most patients continue to need some blood pressure medication.
What results can be expected?
In clinical trials comparing renal denervation with a sham (placebo) procedure, renal denervation lowered blood pressure on average, and the effect has been sustained over several years of follow-up. The response varies between individuals: some people have a larger reduction, while others have little change. Renal denervation is not a cure for high blood pressure, and a healthy lifestyle and regular monitoring remain important.
Possible risks
As with any catheter procedure, there are some risks, including:
- Bruising, bleeding or a collection of blood at the access site
- Injury to the blood vessels, such as a tear (dissection) of the renal artery
- Narrowing of the renal artery in the longer term (uncommon)
- Reactions to the X-ray contrast dye, or effects on kidney function
Your cardiologist will explain the possible benefits and risks in relation to your own situation before you decide.
Frequently asked questions
Will I be able to stop my blood pressure medicines?
Some patients are able to reduce the number or dose of their medicines, but most continue to need some medication. The procedure aims to lower blood pressure and support long-term control.
Is the procedure painful?
You may feel some discomfort while energy is being delivered. This is managed with sedation and pain relief during the procedure.
Is renal denervation suitable for everyone with high blood pressure?
No. It is considered for selected patients after a full assessment. For many people, lifestyle changes and medicines remain the main treatment. Read more about high blood pressure.
Consultation
Renal denervation at The Harley Street Heart & Vascular Centre is performed by Dr Rohit Khurana, Senior Consultant Cardiologist, who has a special interest in resistant hypertension and its treatment by catheter-based interventions. If your blood pressure remains high despite treatment, you can book a consultation to discuss whether renal denervation may be suitable for you.
