Treating Resistant Hypertension: Renal Denervation, life style changes Vs Dangerous Coupling or COUPLER device to connect Art & Vein Blood FLOW

Resistant Hypertension: Renal Denervation, life style changes Vs Dangerous Coupling  or COUPLER device to connect Art  & Vein blood FLOW.

 

 

Hypertension can usually be controlled with medication and lifestyle changes. On the other hand, up to one in 10 people have resistant hypertension that doesn't respond well to blood pressure medications  and 1in 20 who do not respond to any kind of medication. For these people, there may be a new treatment alternative. According to new research published in the journal Lancet, a minimally-invasive procedure that uses radiowaves could help people with drug-resistant hypertension get their blood pressures under control.

Better New Way to Treat Resistant Hypertension?

 

This blood pressure-lowering procedure called renal denervation, or RND, involves inserting a catheter into a groin artery and guiding it into the renal artery that leads to the kidney. Once it reaches the renal artery, the catheter is programmed to put out bursts of radio waves. These radiowaves inactivate small nerves that lie over the renal artery. These nerves stimulate the kidneys to produce hormones that raise blood pressure.

 

RND for Drug-Resistant Hypertension: The Bottom Line?

This is an exciting new development for people who are unable to control their blood pressures through conventional means. Stay tuned for more research about this new treatment for resistant hypertension.

Two companies are at the forefront of it.  Ardian Medical now Medtronic  and Vessix Medical now part of Boston Sci. The market is $2 Billion worldwide.

US represent approx 1/3 of the market.

AMA: Recommends some guidelines. The first step is to determine whether a person actually has resistant hypertension, which isn't the same as uncontrolled hypertension, the committee said. Successful treatment of resistant hypertension requires consideration of lifestyle factors that contribute to the problem, diagnosing and treating secondary causes, and using multiple drug treatments effectively.

Lifestyle factors noted by the AMA committee included weight, salt intake and alcohol consumption. Obesity is associated with more severe blood pressure and losing weight can lower blood pressure and reduce the number of medications needed to control blood pressure. High dietary salt intake is common among patients with resistant hypertension. In patients with general high blood pressure, reducing salt intake can lower blood pressure. Heavy alcohol intake is also associated with resistant hypertension.

The committee also listed a number of health conditions that can contribute to resistant hypertension. They include: obstructive sleep apnea, renal parenchymal disease, primary aldosteronism and renal artery stenosis. Treating these conditions may improve blood pressure control.

Medications were the third area covered by the committee. They said the use of drugs that increase blood pressure, such as non-steroidal anti-inflammatory drugs (NSAIDs), should be reduced or halted, if possible, in patients with resistant hypertension.

The committee noted that diuretics are often underused in people with resistant hypertension. They also said some patients may benefit from adding mineralocorticoid receptor antagonists (MRAs) to their treatment regimens. MRAs treat primary aldosteronism, which is found in about 20 percent of people with resistant hypertension.

"The benefit of mineralocorticoid receptor antagonists in treating resistant hypertension has only been recently confirmed," writing committee chair Dr. David A. Calhoun, a professor of medicine in the Vascular Biology and Hypertension Program at the University of Alabama in Birmingham, said in a prepared statement.

Possible Risks associated with Vascular treatments using COUPLER or Coupling Device to connect Artery & Vein FLOW!!

Health care professional have to be careful of using technologies that are not proven. For example the risks associated with devices in clinical trials like arterio-venous COUPLER or coupling devices or shunts that divert the high pressure arterial blood FLOW into the veins.  Experts suggest that this procedure is going to increase more pressure in the veins and load on the Right side of the heart possibly adding a risk for Right Heart Failure. Causes increased venous statsis, lead to venous ulcers, incompatible venous valves, swelling of the leg, reducing mobility in obese patients, and we can go on and on, increased cardiac output, heart rate.  "I would not touch this artery to vein coupling  procedure as a physician or as a patient. We have better choices!! "said one expert.
Another risk associated with this procedure is ‘the procedure itself”. Poking the artery and letting it bleed until you connect it to a vein is unimaginable in this day an age. Very barbaric, thinking of this procedure makes me hypertensive, you can bleed profusely in a high pressure system and harm vital organs, induce portal hypertension, reduced supply to your genital area ...can it possibly cause erectile dysfunction with a coupling device to treat drug resistant hypertension . To top it all the procedure may be done with more guess work and experience (many doctors work with arteries in flouroscopy, with vein its hard to work with!! In the cath lab. Those who are in interventional cardiology will get it!! Some doctors are enthusiastic to see “what happens”. This coupling devices to treat hypertension is way "TOO RISKY” and “absolutely useless"  vs the more proven minimally invasive renal denervation and another 100 medical devices in this space. Another aspect of this coupling device is that this device cannot be removed, so not technically non-removable, if you want to reverse the effect you might have to patch the hole in the artery..the long term risk may out weigh the tiny benefit and potential for a post market liability from a corporate perspective, distributor or physician perspective.