I was flicking through TIME when I saw a pink kidney. Drawn to the bright colours I read the article attached to it, which turned out to be quite interesting...
A new surgical treatment for hypertension (high blood pressure) is on the horizon and approaching fast. It was mentioned in the Telegraph in 2009, New Scientist wrote about it in 2010, and now Dr. Oz has written about it in TIME (the article that caught my eye).
Hypertension is when your blood pressure is above 140/90 mmHg. Your blood affects just about every organ in your body. So, if there's a problem with your blood, it has a large knock-on effect on many areas of the body. For starters, it can lead to many deadly diseases. It increases the workload of your kidneys which can lead to kidney failure; it can cause your arteries to harden which can cause heart attack; and it increases your risk of a stroke. But, not only can it kill you, it makes your day-to-day life miserable. The increased pressure in your eyes can impair your sight. If blood vessels supplying blood to your arms and legs are damaged, this can cause pain in your limbs - especially when walking (Peripheral Vascular Disease). And something less commonly known: hypertension ages you. If you have it, it adds a huge 12 years to your real age, which leads to wrinkles, and, if you're male, impotence. You also have to book and travel to frequent hospital appointments, have a special diet, and take pills every day. Basically, it’s a right old party pooper.
Normally hypertension is treated using drugs and lifestyle changes (less salt, more exercise). Thing is, the drugs that are used affect your whole vascular system, which in turn affects other systems. This means there are quite a few side effects. You may put on weight, feel tired, have kidney complications, and again, impotence (unlucky chaps!). The medication is also fairly unreliable; in 2009 1 in 10 patients had uncontrolled blood pressure, even when using multiple medications.
As a result, surgery looks quite attractive. The new method itself was actually born in the 1930s, when it was found that a bundle of nerves near the arteries going to your kidneys control the hormones that are responsible for your adrenaline levels. In the process the hormones affect your blood pressure. Doctors found that by surgically disabling these nerves, they could interrupt the signal from the brain that keeps blood pressure raised. However, this operation was intrinsically invasive, which made it risky and could lead to further complications. Mainly for this reason, it was abandoned in favour of drug treatments.
Now, a team of researchers have come up with a solution that is much less invasive. The new technique does away with the scalpel and instead it uses a catheter and radiological guidance – similar to an angioplasty. The catheter is guided to where the nerves are, and a small jolt of electricity reduces the nerve’s activity by 30 – 80%. As the temperature increase is only 10°C, there is minimal damage to the artery. Also like an angioplasty, the risks from this type of surgery are much smaller than traditional surgery. The recovery time is also much shorter; a patient can expect to have the surgery and walk out the same day.
Many clinical trials have been conducted to test this procedure since 2009. Researchers have published a study in Lancet that describes a trial on patients whose systolic BP (the higher number) was greater than 160mmHg. The study showed that 84% of the test group, who underwent Renal Sympathetic Nerve Ablation as the procedure is being called, showed a reduction in systolic BP of at least 10mmHg compared to the control group. More promisingly, nearly 40% of the patients saw their blood pressure return to normal levels.
Furthermore, the first Renal Nerve Ablation procedure was done on a man in 2008. His blood pressure has remained under control to this day, which indicates that the procedure is also permanent. This could mean that patients may not need drugs to control their BP in the future. Hypertension may have a cure.
Each procedure is fairly expensive; it costs the NHS – and therefore the taxpayer – around £4,000 a pop. However this cost is easily balanced by the money it saves in the long run. Patients who don’t have the procedure will have long term medication costs, and they will be at a higher risk of life threatening diseases – which apart from causing harm to the patient, will also cost more for the NHS to fix.
Although still in trial stages, the procedure shows huge potential and its effects on the medical world could be profound. From medical school, doctors are taught that hypertension is best treated using medication, but now this mechanical procedure could replace that.
The procedure will be put into wider use later this year as part of a larger trial. So to finish, at least for those with hypertension, 2012 will not be the end of the world.
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Technology and Techniques