Inova offers two game-changing treatments for high blood pressure

For the past year, Inova Schar Heart and Vascular has offered ultrasound-based renal denervation (uRDN), a minimally invasive procedure to help people with high blood pressure that is tough to treat (known in the medical world as “resistant hypertension”). More recently, the health system also added radiofrequency-based renal denervation (rRDN) at both Inova Alexandria and Inova Loudoun hospitals. These two cutting-edge and game-changing procedures offer new hope to people with high blood pressure that doesn’t respond well to medicines.

What is resistant hypertension, and why is it important?

Blood pressure is listed as two numbers, and for a person with normal blood pressure, those numbers are less than 120 mm Hg systolic (the top number) over 80 mm Hg diastolic (the bottom number). Fifteen million American adults have resistant hypertension, which is defined as:

• Having a systolic blood pressure over 140 mm Hg or a diastolic over 90 mm Hg, even though you are on three blood pressure medications

or

• Needing four or more medications to control your blood pressure

If it’s not well controlled, resistant hypertension increases a person’s risk of heart attack, heart failure, stroke, kidney disease and other cardiovascular complications by more than 15%. In addition, blood pressure medicines can become less effective over time for people with resistant hypertension, giving them fewer options to control their blood pressure. In cases where traditional treatment using medications is not effective, these two new procedures are now available as one-time treatments to help patients find a solution to their stubbornly high blood pressure.

“At our comprehensive resistant hypertension program, we have the appropriate expertise to bring a personalized approach to each patient, enabling us to participate in shared decision making and ultimately make an informed decision about which therapy is best for our patients,” said Behnam Tehrani, MD, Associate System Director for Interventional Cardiology and Executive Director of Cardiac Catheterization Laboratories for Inova Schar Heart and Vascular.

How do the uRDN and rRDN procedures work to lower blood pressure?

Renal denervation works by stopping some nerves in the kidneys from telling the body to store so much fluid and sodium. With less extra salt and water in the body, blood pressure goes down.

Both uRDN and rRDN are minimally invasive, outpatient procedures. Patients are given moderate sedation to relax them, but the procedures don’t require general anesthesia. The clinical team accesses the blood vessels through an artery near the top of the leg and threads a tiny wire over a catheter to the blood vessels of the kidneys. The two procedures use slightly different techniques to achieve the same goal of deactivating nerves:

• In uRDN, the catheter has a balloon tip that inflates and releases ultrasound-guided energy in seven-second bursts to the nerves of the main renal artery and its associated branches
• In rRDN, the catheter is tipped with four electrodes that deliver radiofrequency energy over 60 seconds to the nerves of the main renal artery and its associated branches

The procedures take one to two hours, and patients typically go home the same day. Clinical trial data demonstrate that both procedures can result in an average systolic blood pressure drop of up to 10 points after 60 to 90 days, significantly reducing the risk of cardiovascular complications.

“In our early experience of patients undergoing this therapy, we have noted a reduction in the amount of medicine needed to control high blood pressure at 90 days,” said Dr. Tehrani.

“We’re very excited about these technologies,” said Rajat Garg, MD, Director of the Cardiac Catheterization Lab at Inova Loudoun Hospital. “Aside from medications, there haven’t been any new treatments for hypertension in decades. The fact that we can offer this in a safe, minimally invasive way, with outstanding results that minimize patients’ risk for future cardiovascular events is huge.”

Outpatient consultations to be evaluated for the procedure are available through:

• Inova Cardiology, 571-472-2900
• Virginia Heart, 703-621-4501

Four interventional cardiologists are available to perform these procedures at Inova Alexandria, Inova Fairfax and Inova Loudoun hospitals.

• Behnam Tehrani, MD
• Edward Howard, MD
• Rajat Garg, MD
• Eric Pauley, MD