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Imagine going through life with an extremely elevated blood pressure that cannot be controlled by medication, walking around for months and years with dangerously high risks of blindness, stroke, heart attack or even heart failure.
More than 75 million American adults are living with hypertension; nearly 1 in 3 adults, according to the CDC. Of that, up to 10 percent, or around 7 million people, have treatment-resistant hypertension, where their blood pressure remains high (over 140/90 mmHg) despite treatment with at least three or more different types of blood pressure medications (including a diuretic).
Penn Medicine is the first in the region to begin testing a new procedure to help people whose high blood pressure can't be controlled using currently available medications.
"Many of our patients have tried diligently to get their blood pressure under control, through medication and lifestyle changes, to no avail," said Debbie Cohen, MD, co-investigator of the study at Penn and associate professor of Medicine in the division of Renal, Electrolyte and Hypertension. "So we're trying an approach that makes physiologic sense in hopes that it will denervate the renal sympathetic nerves and reduce blood pressure."
This procedure, called renal denervation, is being tested by an interdisciplinary team of hypertension and interventional cardiology experts at Penn. It involves inserting a catheter through an artery in the groin, which is threaded up to the renal artery, where a specific catheter using radio frequency energy is used to deactive the renal nerves. It doesn't involve a permanent implant and can be performed under conscious sedation.
"In this clinical trial, we are studying whether the procedure effectively get the patients back to their target blood pressure," said Robert L. Wilensky, MD, co-investigator of the study and professor of Medicine in Interventional Cardiology. "We've done a number of procedures at this point and are ahead of our recruitment goal, which indicates the real unmet need for people with complex hypertension."
The approach works to control the activity of nerves going in and out of the kidneys responsible for regulating the sympathetic nervous system, which plugs into the body's system to regulate blood pressure. If the nerves are overactive, hypertension can ensue.
The procedure is still being tested in a clinical trial, and is only being used in controlled research studies. Penn is actively recruiting at least 15 patients for the study and is on track to reach enrollment goals around June; results should be available a few months later. The procedure is already approved and available in Europe, Australia and New Zealand.
If the results of the current study prove positive, researchers anticipate that renal denervation may become an important approach to treatment for patients with difficult to control high blood pressure.