Presented by Dr. Paul Ong, a renowned cardiologist with extensive experience in interventional cardiology, renal denervation (RDN) is gaining recognition as a modern option for managing hypertension. In this article, we explore what RDN is, how it works, and why it is becoming a crucial part of hypertension treatment strategies.
Why Hypertension Remains a Challenge
Hypertension affects over a billion people worldwide, yet fewer than 20% achieve adequate blood pressure (BP) control. Traditional treatment approaches, including medications and lifestyle modifications, are effective for many but fall short for others due to:
- Non-Adherence to Medication – Many patients struggle to maintain their medication regimen, with studies showing partial or total non-adherence in a significant number of cases.
- Medication Intolerance – Side effects and the complexity of multiple medications (polypharmacy) can discourage patients from continuing their treatments.
- Uncontrolled Resistant Hypertension – Even with three or more medications, some patients fail to achieve target BP levels.
Uncontrolled hypertension dramatically increases the risks of heart attack, stroke, and kidney failure, underscoring the need for alternative approaches.
What Is Renal Denervation?
Renal denervation is a minimally invasive procedure designed to reduce BP by disrupting overactive signals in the renal nerves. These nerves, located in the walls of the renal arteries, play a key role in regulating BP by modulating communication between the kidneys and the brain.
Using a catheter, a cardiologist delivers targeted radiofrequency (RF) energy to the renal nerves, disrupting their activity. The procedure is straightforward and requires no permanent implants. Patients typically undergo RDN under moderate sedation, with the entire process lasting about 90 minutes.
How Effective Is RDN?
RDN has been extensively studied, with clinical trials demonstrating its efficacy:
- The SPYRAL HTN clinical program showed significant and sustained BP reductions in patients undergoing RDN, both with and without concurrent antihypertensive medications.
- RDN provides an “always-on” effect, reducing BP 24/7 without relying on patient adherence.
For instance, the SPYRAL HTN-OFF MED trial reported a 9.2 mmHg drop in systolic BP at three months, while patients in real-world registries saw sustained reductions over several years.
Who Is a Candidate for RDN?
RDN is particularly beneficial for:
- Patients with Uncontrolled Resistant Hypertension – Those with BP ≥140/90 mmHg despite taking three or more medications.
- Patients Intolerant to Medications – For individuals unable to tolerate antihypertensive drugs, RDN provides an alternative path to BP control.
- Patients with High Cardiovascular Risk – Those with hypertension-mediated organ damage or elevated global cardiovascular risk may also benefit.
Dr. Ong emphasises the importance of careful patient selection, involving multidisciplinary teams to evaluate eligibility and manage expectations.
What Are the Benefits of RDN?
RDN offers several advantages, including:
- Reduced BP Without Medication Burden – Patients experience clinically meaningful BP reductions without increasing medication dosages or adding new drugs.
- Minimised Risks – Studies have shown RDN to be safe, with minimal impact on renal function and a low rate of adverse events.
- Convenience – The procedure is quick, with most patients resuming daily activities within a week.
Real-World Success: A Patient Story
Dr. Ong shared the story of a 54-year-old man with longstanding hypertension. Despite trying multiple medications, he struggled with side effects and inconsistent results. After undergoing RDN, his BP began improving within weeks, allowing him to reduce his medication burden and feel better overall.
What to Expect During RDN
The RDN process includes:
- Pre-Procedural Assessment – Confirming eligibility through BP measurements, imaging studies, and other evaluations.
- The Procedure – A catheter is inserted into the renal artery, and RF energy is delivered in a controlled manner.
- Post-Procedural Care – Patients are observed overnight and typically discharged the next day. BP improvements occur gradually over several months.
A Bright Future for RDN
Renal denervation represents a third pillar in hypertension management, complementing lifestyle changes and medications. As research continues, its role is expanding, providing hope for patients who have struggled to control their BP.
Dr Paul Ong of The Heart Specialist and his team at Mount Elizabeth Novena Specialist Centre and this innovative approach, offer specialised care and guidance to patients exploring RDN.
If you or someone you know is facing challenges with hypertension management, consider discussing renal denervation as a treatment option with a specialist.
