New revolutionary technique for the treatment of resistant h

By Dr. José Baptista [email protected]

Prof. Dr. José Baptista MD. PhD is a Cardiologist and Subspecialist in Interventional Cardiology, a Director of the (U.I.C.) at Hospital Particular do Algarve and Member of the Scientific Board of the European Association of Percutaneous Coronary Interventions (EAPCI).

Portugal has one of the highest mortality rates in Europe due to cerebral vascular accident or stroke. One of the main high risk factors is high blood pressure (HBP).

It is estimated that in Portugal there are approximately two million people suffering from HBP.

According to a study published by well known Cardiologist Prof. Espiga de Macedo, two out of every five Portuguese adults suffer from HBP and only one in 10 is being correctly medicated.

Blood pressure equal to or above 140/90mHg is considered HBP. The vast majority of patients affected by this disease, 90% of whom do not have an established cause, have no symptoms.

A patient’s motivation to take daily medication for the rest of their life is therefore very low. As a rule, symptoms only develop on a medium to long term basis, when vital organs such as the liver, vision, brain or heart are affected, when the patient starts suffering from arterioesclerosis, renal failure, cardiac insufficiency, heart attack and stroke.

In some patients, HBP can be so severe that even with multiple medication blood pressure cannot be controlled (resistant HBP).

For this group of patients, there is new hope known as Renal Sympathetic-Nerve Ablation by Radiofrequency Catheter.

This revolutionary technique is already available in Portugal and Hospital Particular do Algarve will be one of the first centres worldwide where this technology is available.

This treatment consists in the patient undergoing a catheterism under local anesthesia, with a small catheter (small 2mm tube) being introduced in the groin region and placed in both renal arteries.

The other end of this catheter is then connected to a generator which emits a radiofrequency shock (similar to what is already practiced for the treatment of cardiac arrhythmia). This causes a selective interruption of the nervous stimuli between the kidney and the brain which is the mechanism that is the genesis of HBP.

One of the first studies published by the famous journal The Lancet (Symplicity HTN-2 Trial), important and continued reduction of BP was observed in patients with resistant HPB (i.e. continuous High BP even though they were taking three different types of medication) with an average reduction value in systolic BP of 32 mmhg, which corresponds roughly to the results that would be obtained with the combination of two different types of medication.

This new technology promises to be as revolutionary as coronary angioplasty was for the treatment of myocardial infarction when it first appeared.

It will most certainly bring about a change in the methods used today for the treatment of HBP.

More extensive studies are necessary in order for this technique to be used for the treatment of less serious cases. One of the possibilities which are being considered at the moment is that this treatment might be sufficient in controlling blood pressure – in mild hypertension, leaving the patient medication free.

This new technique can only be performed in Hemodynamic Laboratories, by specialist cardiologists, specialising in cardiac intervention with experience in peripheral angioplasty, an area the Hospital Particular do Algarve was pioneer 10 years ago.