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Here is a category of people with high blood pressure that I hope you never find yourself in: treatment resistant hypertension. Any degree of high blood pressure is bad enough, but at least most people can bring it under control with appropriate changes in the diet, losing some weight and a carefully calibrated drug regimen.

It doesn’t work that way for treatment resistant hypertension.

This severe form of hypertension is defined as consistently high blood pressure despite taking three or more different antihypertensive medications at optimal doses. Some researchers believe that nearly 1/3 of people with high blood pressure may fall into this category. Patients with treatment resistant hypertension are more than three times as likely to have a heart attack or stroke compared to other people with high blood pressure that can be controlled.

Now there is a completely different approach to treatment of people with this problem that is showing extremely promising results in trials around the world. It’s called the Symplicity Renal Denervation System. The company that developed it, Medtronic, is best known for their highly sophisticated pacemakers but they are also on the forefront of medical technology in many other areas as well.

You’re probably aware that the kidneys play a very important role in the normal day-to-day regulation of blood pressure. For one thing, they control the amount of fluid in our circulation. If we drink a lot of water, we pass out the excess in our urine. On the other hand, if we are not taking in enough fluids the kidneys hold onto as much as they can to keep us from becoming dehydrated.

The kidneys also produce hormones that can increase blood pressure. And they are influenced by activity in the sympathetic nervous system. Increased sympathetic activity is part of the fight or flight syndrome and a high sympathetic input to the kidneys leads to high blood pressure.

Researchers have discovered that over activation of the sympathetic nervous system is a factor in many people with chronic high blood pressure. The Symplicity System was developed to reduce blood pressure by interrupting hyperactive input to the kidneys through the sympathetic nerves.

The procedure requires very sophisticated technology, but it’s actually very easy on the patients. In the procedure, a small flexible catheter is passed from the artery in the groin upstream to the area of the kidneys, much like cardiologist threaded catheters through arteries when they do a cardiac catheterization. In this procedure, the catheter is threaded under x-ray guidance into the renal artery, the artery that supplies the kidneys.

Once the catheter is in proper position, it’s connected to the Symplicity generator. This generator produces a low powered radio frequency energy output. Its exact nature of this radio frequency and how it is applied is proprietary by the results in the deactivation of the nerves surrounding the renal artery. This is where the sympathetic nerves that supply the kidney are.

The result is a persistent reduction in sympathetic nervous input to the kidney and a long-term lowering of blood pressure. There is no permanent implant. Nothing is left behind when the catheter is removed.

This system has been in use for over five years in countries around the world, yet the FDA has not yet approved it for distribution in theUS. It seems to me that more and more the FDA is about following their protocols and slowing progress as much as they can rather than doing what’s best for patients.

In any case, clinical trials that the FDA considers worthy of their consideration  are now underway (at the cost of millions of dollars) in theUSand at centers around the world. The preliminary results are very positive.

For example, in one analysis there were 34 patients that had the procedure three years previously and showed a reduction in blood pressure of 31 mmHg in their systolic blood pressure and 16 mmHg in their diastolic blood pressure. That’s a dramatic improvement for anyone, but remember that these are people who were completely resistant to treatment previously. For these people, that result is truly amazing.

Currently, this treatment is only available to patients participating in research studies. Let’s hope it’s not too long before it’s available to all who need it.

You can read more about the studies here:

www.symplifybptrial.com

 

 

 

 

 

 

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