WASHINGTON — Michael Garrity faced a daunting challenge with his persistently high blood pressure—tried numerous medications without success. However, a groundbreaking procedure that targets specific nerves in his kidneys has proven transformative for him.
This innovative treatment, known as renal denervation, works by disrupting the hyperactive nerves that play a role in regulating blood pressure. Garrity, 62, from Needham, Massachusetts, shared, “My blood pressure would spike, and I’d run out of breath and feel tired, and that doesn’t happen anymore.” He still takes medication but at reduced doses, enjoying normal blood pressure levels for the first time in years. “I’m thrilled,” he added.
Hypertension, or high blood pressure, affects nearly half of adults in the United States, posing significant risks for serious health issues like heart attacks, strokes, kidney failure, and even dementia. Alarmingly, many individuals remain unaware they have high blood pressure until it causes severe complications. Dr. Randy Zusman from Massachusetts General Hospital emphasizes, “Know your blood pressure, know the numbers,” urging everyone to get their blood pressure checked at least annually, regardless of how they feel.
Only a small percentage of individuals with high blood pressure manage to keep it under control effectively, indicating a pressing need for new treatment options. The FDA approved renal denervation roughly a year ago, following studies that highlighted its effectiveness in patients who struggle with hypertension despite taking multiple medications. The recent endorsement from the American Heart Association has prompted hospitals, including Mass General Brigham, to cautiously consider offering the procedure while they assess which patients may benefit most and whether insurance will cover the costly, minimally invasive treatment.
Understanding high blood pressure typically involves two measurements: the systolic pressure, representing the force of blood against artery walls while the heart pumps, and the diastolic pressure, which is measured between heartbeats. Normal blood pressure readings are generally less than 120 over 80. While blood pressure can fluctuate throughout the day due to activity and stress, a consistent reading of 130 over 80 or higher can indicate a problem, leading to hardened arteries and increased workload on the heart.
Blood pressure doesn’t require a doctor’s visit for measurement. Many pharmacies, and even some libraries, provide blood pressure screening, and home monitors are available as well. To ensure accurate readings, the American Medical Association advises sitting quietly with feet flat on the floor and keeping one’s arm supported on a table.
Lifestyle changes are often the first recommendations for managing high blood pressure, especially in otherwise healthy individuals. Guidelines recommend losing weight, exercising, consuming more fruits and vegetables, reducing salt and alcohol intake, and managing stress levels. When blood pressure reaches 140 over 90, medication is typically required. According to Dr. Zusman, most patients often need two or three different drugs, alongside lifestyle modifications.
Garrity has struggled with high blood pressure since his late 20s, despite following a strict regimen of four to six medications and a healthy lifestyle, his blood pressure remained alarmingly high.
The renal denervation procedure involves threading a small catheter through blood vessels to reach the kidneys and delivering ultrasound or radiofrequency energy to targeted nerves around the renal arteries. Dr. Joseph Garasic, an interventional cardiologist at Mass General, performed the procedure on Garrity, which takes about an hour. Initially, the procedure faced setbacks, but after modifications and a decade, the FDA approved two catheter systems developed by Recor Medical and Medtronic in November 2023.
While renal denervation isn’t a cure and may not benefit everyone, studies indicate an average reduction of 8 to 10 points in blood pressure for those who respond well. Many patients, including Garrity, experience a significant reduction, enabling them to decrease their medication intake gradually. Although the FDA has deemed the procedure safe for select individuals, it has not been tested in patients with kidney disease or narrowed arteries, and research thus far has only spanned a few years, which is insufficient to determine if nerve regeneration occurs post-procedure.
The American Heart Association advises comprehensive discussions between potential patients and their healthcare providers to ensure the best decision regarding this treatment option.
