Medicare expands coverage for innovative procedures to treat stubborn high blood pressure

The Centers for Medicare & Medicaid Services (CMS) recently completed its analysis of two procedures to help people with tough-to-treat high blood pressure (also known as “resistant hypertension”). The CMS analysis expands insurance coverage to these procedures for Medicare patients. Inova Schar Heart and Vascular offers both procedures – radiofrequency renal denervation (known as rRDN) and ultrasound renal denervation (known as uRDN) – to treat stubborn high blood pressure.

Inova’s team has had great results with both procedures. The procedures have reduced:

• Patients’ systolic blood pressure (the top blood pressure number) by an average of 25 points
• Patients’ diastolic blood pressure (the bottom blood pressure number) by an average of eight points

Lowering patients’ blood pressure numbers reduces their risk of heart attack, stroke and other cardiovascular problems.

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

People who need three or more medications to control their blood pressure may be evaluated for uRDN or rRDN as a treatment option.

Poorly controlled high blood pressure increases a person’s risk of heart attack, heart failure, stroke, kidney disease and other cardiovascular complications by more than 15%. And because high blood pressure medicines tend to lose their effectiveness over time, when that happens and blood pressure begins to rise, so does the risk of cardiovascular complications.

“Patients have noted improvements in their quality of life and have been able to reduce their reliance on medication to control their blood pressure,” said Behnam Tehrani, MD, Associate System Director for Interventional Cardiology, Executive Director of Cardiac Catheterization Laboratories for Inova Schar Heart and Vascular, and Co-Director of Inova’s Complex Coronary Therapeutic Program. “These are impressive results and offer a transformative change in the options available to treat resistant hypertension. This allows us to bring a personalized approach to each patient, partnering with them and their primary physician to ultimately make an informed decision about which therapeutic option is best.”

Dr. Tehrani was one of several national leaders who offered comments during CMS’s national coverage analysis review period that resulted in expanded insurance coverage for these procedures.

How the new CMS analysis expands access to uRDN and rRDN

The CMS analysis expands access to uRDN and rRDN across Medicare. This is a significant improvement over the previous rule, which only covered the procedure for those in traditional Medicare plans. In addition, because most private health insurance plans follow CMS’s lead, more private plans are expected to cover these procedures. As with many procedures, prior authorization may be needed to ensure patients meet the medical criteria for uRDN or rRDN.

Overview of uRDN and rRDN

In late 2023, the U.S. Food and Drug Administration approved renal denervation as a treatment for patients with resistant hypertension. 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.

“We’re very excited about these technologies,” said Eric Pauley, 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.”

“Given the number of patients struggling to manage their hypertension, providing this procedure at Inova Alexandria Hospital is life-changing for our patients,” said Edward Howard, MD, Director of the Cardiac Catheterization Labs at Inova Alexandria Hospital.

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

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

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

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