Refractory hypertension is a type of hypertension that is difficult to control, and even through lifestyle changes and the use of antihypertensive drugs, it is difficult to achieve ideal antihypertensive effects. In this situation, the patient's risk of heart disease, heart failure, kidney disease, and stroke increases.
Recently, a study published in the JAMA journal titled "Endovascular Ultrasound Renal Denervation to TreatHypertension" showed that intractable hypertension can be treated through a subcutaneous procedure similar to stent implantation.
This minimally invasive surgery uses ultrasound energy delivered through small balloons to cut off the nerve supply to the renal artery. This method is called ultrasound renal denervation (uRDN) and can be used alone or in combination with antihypertensive drugs to target excessive activity of renal nerves.
This randomized clinical trial recruited a total of 224 patients with refractory hypertension, co authored by Dr. Stephen Jenkins, head of the interventional cardiology department and director of interventional cardiology research at OchsnerHealth.
Ochsner Hospital participated in the RADIANCE-HTN series of trials studying the treatment of refractory hypertension with ultrasound renal nerve removal surgery, "said Dr. Jenkins. In this critical, randomized, multi-country trial, Ochsner Hospital is the second largest recruiting institution in the United States. This simple catheter based surgery provides an alternative drug treatment method for the treatment of hypertension by reducing sympathetic nerve activity in the arteries to alleviate the pressure of high blood pressure
At present, in addition to lifestyle changes and medication treatment, endoscopic catheter renal nerve removal (RDN) has become a method for treating refractory hypertension. Traditional RDN surgery uses radiofrequency ablation technology to cauterize nerves located within the renal artery, in order to reduce nerve activity and thereby lower blood pressure.
The uRDN system is a minimally invasive surgery. The surgery involves inserting a small flexible catheter into a small hole in the wrist or groin, and then placing the catheter inside the artery that supplies blood to the kidneys. By transmitting radio frequency or ultrasound energy to the surrounding tissues of the arteries for a few seconds, neural activity is reduced and blood pressure is lowered. After both kidneys have undergone surgical treatment, the equipment will be removed.
Two previous sham controlled trials have shown that uRDN can reduce blood pressure in patients with mild to moderate and refractory hypertension. The latest study conducted a larger scale trial in a group of patients with refractory hypertension and demonstrated the effectiveness and safety of the therapy, which is also applicable in this patient group: two months after treatment, the patient's blood pressure continues to decrease, indicating that uRDN has the potential to become an alternative to medication.
In addition, a study published in JAMACardiology, titled "Patient Level Pooled Analysis of Ultrasound Renal Activation in the Sham Controlled RADIANCEII, RADIANCE-HTNSOLO, and RADIANCE-HTNTRIOTrials," summarized and analyzed three randomized clinical trials, namely RADIANCESOLO, RADIANCETRIO, and RADIANCEII. The results showed that uRDN had consistent antihypertensive effects in a wider range of hypertension.
In addition, this therapy has other advantages. Compared to traditional RDN therapy, uRDN has fewer complications and a higher success rate. Due to its ability to perform in any clinical environment, uRDN can provide an effective alternative for patients who are unable to tolerate or receive medication.
Of course, like all medical treatments, uRDN also has some potential risks and limitations. Patients may experience risks such as rapid blood pressure drop, shock, renal dysfunction, or vascular damage during the treatment process. In addition, more research is needed to confirm the long-term safety and effectiveness of this therapy.
Overall, uRDN is a novel treatment method for refractory hypertension, which utilizes ultrasound energy to act on the tissue surrounding the renal artery, reducing neural activity and thereby lowering blood pressure. Compared to traditional treatment methods and other surgical treatments, uRDN has significant advantages and can provide patients with more convenient, safe, and effective treatment methods. Although more research is still needed to further confirm its long-term efficacy and safety, this therapy has been proven to be a very promising method for treating refractory hypertension.
