New Methods in Treatment of Hypertension

What is Hypertension?

Cardiovascular diseases are the primary cause of mortality in the world. The most important risk factors leading to cardiovascular diseases include hypertension, diabetes mellitus, high cholesterol and triglyceride, smoking, and history of a cardiovascular disease in the family at young ages.

Hypertension (High Blood Pressure) is defined as values being higher than normal values accepted in the society: Systole ≥ 140 mm Hg or Diastole ≥ 90 mm Hg (International organizations define different limit values for different risk groups).

Hypertension produces a great risk for stroke, coronary heart disease, heart failure, renal disease, and leg vascular disease.

The most important cause of mortality in the world is cardiovascular diseases.

How Should A Treatment Be?

The blood pressure should be reduced to lower values in all patients with “Hypertension”; systole should be under 140 mmHg and diastole should be under 90 mmHg as long as the patient does not feel uncomfortable.
Target blood pressure should be lower than 130/80 mmHg at least in diabetic patients, and patients at high or very high risk such as patients with related clinical conditions (e.g. stroke, myocardial infarction, renal disease, proteinuria).

Primary Medications to Reduce High Blood Pressure:

  • Diuretics
  • Calcium Canal Blockers
  • Beta-blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)

A large number of patients can be controlled by 3 drugs in treatment of hypertension.

In Treatment of Hypertension 

Benefit from Drop in Blood Pressure

Lowered blood pressure ensures a significant decrease in cardiovascular diseases. An effective treatment provides decrease in stroke by 36%, coronary artery disease by 27%, and all cardiovascular diseases by 32%. Reasonably lowered blood pressure has been shown to provide following benefits:
Prevention or delay of development of chronic renal failure
Prevention of development of heart failure and improvement of its current symptoms
Prevention of stroke and its recurrence

Lowering diastole to 10 mmHg provides reduction in stroke by 56% and coronary heart disease by 37%. Lowering systole to 10 mmHg provides reduction in the risk of stroke by 20 to 40%.

New Treatment Method Where Pharmacotherapy Falls Behind

In the cases where pharmacotherapy falls behind, renal sympathetic nerves arise from thoracic and spinal segments and follow renal artery to the kidneys. Afferent and efferent nerve fibers extending along the renal artery together makes this anatomical area available for a possible intervention. Nerve fibers are twisted together along the axis to form a network in these vessels.

Denervating these nerves by controlled heating through a catheter has turned a new page in the treatment of blood pressure. An example of the device and catheter used for this purpose is shown below.

These catheters are used to heat and desensitize inner face of the vessel wall so that adverse effect of sympathetic nerve tissue over blood pressure can be reduced.

Selection of the patient to use this method is based on the main criteria used in scientific clinical studies demonstrating reliability and effectiveness of treatment. The persons who will receive Renal Denervation

Should have a systolic blood pressure greater higher than the target despite reasonable pharmacotherapy
Renal filtration function (eGFR) should be ≥ 45 mL/min/1,73m2

  • Should not have Type 1 diabetes
  • Should not have heart valve disease where decreased blood pressure might be dangerous
  • Should not be pregnant
  • Should have suitable structure of renal artery
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The information on this website is not intended to replace any medical advice given by physicians with access to your detailed medical history.