Health | It is crucial to maintain blood pressure under control. There is a brand new option for difficult cases

By LAURAN NEERGAARD

WASHINGTON (AP) — Nothing doctors prescribed controlled Michael Garrity's dangerously hypertension — until they removed some nerves in his kidneys.

“My blood pressure went up, I got out of breath and felt tired, and that doesn't happen anymore,” said Garrity, 62, of Needham, Massachusetts. He's still taking medication, but at lower doses his blood pressure is returning to normal for the primary time in years. “I’m thrilled.”

About half of adults within the U.S. suffer from hypertension, a significant risk for heart attacks, strokes, kidney failure and even dementia. Many people don't realize they’ve hypertension until it has caused serious damage.

“Know your blood pressure, know the numbers,” emphasized Dr. Randy Zusman of Massachusetts General Hospital, who focuses on the hardest-to-treat cases and advises individuals who think they're doing well to no less than have an annual checkup.

And only a fraction of patients have hypertension well controlled, leaving a necessity for brand new strategies. The Food and Drug Administration approved this “renal denervation” option a couple of 12 months ago, based on studies showing modest profit in patients whose blood pressure stays high despite multiple medications.

After the American Heart Association recently deemed it promising, some hospitals, including Mass General Brigham, at the moment are cautiously offering it while they determine who’re good candidates — and whether their insurance will cover a minimally invasive procedure that costs hundreds of dollars.

What is hypertension?

Two numbers describe blood pressure. The highest, “systolic” pressure is the force that blood exerts on the partitions of the arteries because it is pumped out of the center. The lower “diastolic” value measures the identical pressure, but between heartbeats.

The normal value is lower than 120 over 80. Blood pressure naturally fluctuates throughout the day and is higher if you end up physically lively or stressed. But when it stays high – consistently 130 over 80 or higher, in keeping with the newest guidelines – it stiffens the arteries and makes the center work harder.

How to measure blood pressure

No doctor's visit is crucial. Pharmacies and sometimes even libraries offer screening, and folks can use monitors at home.

To avoid falsely high readings, the American Medical Association has suggestions: Sit quietly, feet on the ground, legs uncrossed. Place the cuff in your bare arm, not over clothing. Instead of dangling your arm, place it on a table.

Medication is just not the one technique to treat hypertension

Medication is a must once hypertension reaches 140/90. The average patient requires two or three medications, sometimes more, together with a healthier lifestyle, Zusman said.

But the hypertension Garrity has struggled with since his late 20s is proof against treatment. Despite taking 4 to 6 medications in addition to a strict weight-reduction plan and exercise, his blood pressure recurrently reached 150 over 100 or worse.

What is Renal Denervation?

Doctors thread a small catheter or tube through blood vessels to succeed in the kidneys after which beam ultrasound or radiofrequency energy. These impulses go through the renal arteries and selectively goal surrounding nerves, Dr. Joseph Garasic, an interventional cardiologist at Mass General who performed Garrity's procedure. It takes about an hour.

Although already utilized in other countries, a significant U.S. trial of renal denervation failed a couple of decade ago, prompting changes before researchers tried again. In November 2023, the FDA approved two catheter systems from Recor Medical and Medtronic.

It's not a cure – and a few patients don't profit from it. However, Garasic said several studies showed, on average, an 8 to 10 point drop in blood pressure, a modest but vital improvement. Some, like Garrity, see a bigger decline, enough to step by step reduce medication use.

The FDA deemed the procedure secure for rigorously chosen patients — it wasn't tested in patients with kidney disease or narrowed arteries, for instance. And studies have only lasted a number of years, not long enough to say whether the nerves could eventually regenerate.

The American Heart Association's guidelines encourage prospective patients and experienced physicians to have “thoughtful and informed conversations” to make your mind up who’s a superb candidate.

Originally published:

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