What Patients Need to Know About Renal Denervation, with John Giacona, PhD, PA-C

John Giacona, PhD, PA-C, assistant professor in the Applied Clinical Research Department at UT Southwestern Medical Center and certified Hypertension Specialist, says the two main questions he receives from patients about renal denervation are: What kind of blood pressure reduction can I expect? and Is it safe?

He makes sure to tell patients that current data suggests 60 to 70% of those who undergo renal denervation will experience a reduction of about five millimeters of mercury in their blood pressure. This reduction is comparable to what you'd expect from adding one new antihypertensive medication.

However, it’s important to note, he says, that around 30% of patients won’t see any change in their blood pressure. So, renal denervation should not be seen as a cure-all; it's something to be added to your existing treatment regimen. Patients still need to maintain lifestyle modifications like a low-sodium diet, regular exercise and adhere to their current medications. This procedure is an adjunct to other measures—it won’t provide a drastic reduction, and patients shouldn’t expect drastic drops from just this procedure alone.

As for safety, it is a catheter-based procedure performed through the femoral artery, similar to a heart catheterization. The procedure typically takes about an hour, depending on the patient's anatomy and the catheter used. The risks associated with the procedure are minimal and similar to those associated with femoral arterial access, including hemorrhage, infection or hematoma formation. The randomized controlled trials (RCTs) have shown very few adverse events, and only occur in about 10% of patients. In Giacona’s experience, many patients are back at work within two days.

One misconception he often encounters is that patients expect a significant change in their blood pressure because it's a procedure, not a medication. However, the data shows that most patients will not experience a 10- or 15-millimeter reduction. Although the current data is short-term, but over time, he anticipates more long-term data on how sustained the blood pressure reduction is.

A meta-analysis looked at the long-term benefits of reducing systolic blood pressure by five millimeters of mercury. Over four years, such a reduction can lower the risk of major adverse cardiovascular events by 10%, reduce the risk of stroke by 13%, heart failure by 13%, and cardiovascular death by 5%.

“They may sound like small numbers, but that's over a four-year period, and that's really substantial,” he says.

Additionally, if a patient achieves this reduction, they may be able to reduce their dosage or come off a medication that causes side effects, which can be a significant benefit for patients taking multiple medications or struggling with their current treatment.