Ultrasound renal denervation provides a new option for people with resistant hypertension, which is when more than three medications are needed to keep blood pressure under control or levels haven’t been lowered despite these therapies. The Ohio State University Wexner Medical Center was the first hospital in central Ohio to offer this noninvasive procedure.
“We know that when you keep adding more medications, the risk of side effects and drug-to-drug interactions goes up. Even remembering to take multiple medications can be an issue for many people,” says Nkechinyere Ijioma, MD, an Ohio State interventional cardiologist and endovascular interventionist. “This innovative procedure targets the physiology of blood pressure from another angle, and it can either increase the efficacy of existing therapies or, in many cases, reduce the amount or classes of medication that are needed.”
Renal denervation works by changing how the sympathetic nervous system around the kidneys, or renal sympathetics, communicates with the brain, eliminating the feedback that says blood pressure needs to be raised.
First approved by the FDA in November 2023, the procedure involves using an ultrasound machine to essentially bombard overactive nerves so they can no longer overstimulate renal arteries, which are the part of the kidneys that help regulate blood pressure.
Similar to a heart catheterization, the renal artery is accessed via the leg through the femoral artery. Ultrasound pulsations are delivered first along the renal artery and then along the perirenal artery, with each series of waves taking only about seven seconds. The total procedure typically takes one to one-and-a-half hours and, because it’s performed with only a small amount of sedation in the catheterization lab, most people can go home the same day – although older individuals or those at higher risk may be kept overnight for observation.
“For people who aren’t seeing the results they need from lifestyle changes or multiple medications, renal denervation can provide a tremendous advantage,” Dr. Ijioma says. “It’s not a standalone ‘cure,’ but it can improve blood pressure control and, in some cases, help individuals eventually wean themselves off of one or two medications.”
Refer a patient for ultrasound renal denervation
Clinicians who have a patient with resistant hypertension can request a referral to the Ohio State Wexner Medical Center, where specialists from cardiology and nephrology work together in a resistant hypertension clinic.
“If there’s something else driving the hypertension, like a secondary cause that we can cure or treat, we like to address that first,” Dr. Ijioma says. “We’ll evaluate individuals for renal denervation if their blood pressure remains elevated after evaluating for secondary causes of hypertension. It’s not appropriate for everyone, and candidates must have renal arteries within an appropriate size range. If we do move forward, we’ll send people back to their regular provider for ongoing care about a month after the procedure – once we’ve confirmed the results of the therapy.”