Sunday, December 17, 2017

Breakthrough procedure can help patients with high blood pressure

A 41-year-old woman ailing with high blood pressure, resistant to normal medical treatment, has made history, becoming the first patient in the Caribbean to be treated using a breakthrough procedure.

The procedure, called renal denervation, was performed two months ago at the Advanced Cardiovascular Institute (ACI) in Woodbrook, by noted cardiologist and ACI's medical director, Dr Ronald Henry.

Cardiovascular diseases are the leading cause of death in Trinidad and Tobago. Hypertension is the leading attributable cause of death worldwide and costs the global health care system more than $500 billion annually.

Resistant hypertension (high blood pressure) is a nightmare for doctors, said Henry, and leads to frustration amongst its sufferers who despite taking a cocktail of medications, cannot get their blood pressure under control.

Patients whose blood pressure remains uncontrolled, face increased cardiovascular risk.

But with renal denervation and an ongoing treatment with anti-hypertensive medications, patients with resistant hypertension will be able to achieve target blood pressure levels, said Henry.

Renal denervation is a minimally invasive procedure, performed using the Medtronic Symplicity Catheter System, consisting of a catheter and a generator. Catheters are placed into the arteries that feed the kidneys and introduces specially designed wires that then burn off the nerves that run on the outside of these arteries, without causing any damage to the arteries. In so doing, the nerves located in the renal artery walls shrivel back and the blood pressure begins coming down.

The nerves which serve as a communication pathway are 'killed off' with no known detriment to the body. In patients abroad who have been treated with renal denervation, doctors saw a 30 mm drop in the systolic figure (the top figure) and a 20 mm drop in the bottom figure.

"The reason for the new excitement is that nobody realised how predictable this would be and secondly it was not known at the time whether the benefit would be durable—and it is durable. And thirdly, we had to look under the experimental conditions to see if there was any damage and downside to the kidney. And thankfully, to date, there has been none recognised. So this has opened up a whole new possibility," said Henry.

Henry said when he learnt about this procedure he was initially sceptical and adopted a wait-and-see approach. But when follow up studies were done on patients who were treated with renal denervation three years prior, it revealed that 80 per cent of those successfully treated had a sustained reduction in the blood pressure.

"There is nothing out there that has done that. We're talking about a group of people who have tried every medication and their blood pressure was still elevated so when you see an 80 per cent success rate extending over a period of time, that is very dramatic," he said.

Henry was astounded at the results and immediately wanted to introduce it to T&T. It took a year and a half of lobbying, letter writing and phone calls to eventually procure the device needed. Cardiologists in larger countries, eager to try the procedure, used the devices to such an extent that the manufacturers of the machines could not keep up with the demand, the Express was told.

For the time being, Henry is monitoring the progress of his renal denervation patient from south Trinidad, and so far, he says, she is making good strides.