Pressure Relief

It’s hardly a surprise that hypertension can kill you. What is less well known is that it can also age you–a lot. If your blood pressure is above 140/90 mm Hg–compared with the optimal 115/75–a whopping 12 years may be added to your real age. That puts you at increased risk not just of heart attack, stroke and renal failure but also of wrinkles and, if you’re male, impotence.

For years, medication and lifestyle modification have been the baseline treatment for the 25% of Americans who are hypertensive, with some benefiting much more than others and some seeing little improvement at all. That could change in a dramatic way in 2012 with a new procedure that will be made available in Europe and is now undergoing a pivotal U.S. trial: using radio-frequency energy to zap and disable a few select nerves in the kidneys. This has been shown to reduce pressure by an average of 32/12 mm Hg while keeping the surrounding tissue healthy and intact.

The road to so new and improbable a treatment was a long one. In the 1930s, physicians identified a small group of nerves around the kidney arteries that help regulate the hormones behind the fight-or-flight response and in the process regulate blood pressure too. Over the decades since then, doctors discovered that by surgically disabling these nerves, they could lower pressure significantly. The procedure, however, was risky and by definition invasive. At the same time, pharmacologists began developing drugs that could lower blood pressure without all the perils that can come from the sharp edge of a scalpel, and meds thus became the treatment of choice. But they too turned out to have problems.

Any systemic medication that manipulates so fundamental a system as blood pressure–which in turn affects many related systems–can lead to a host of side effects. In the case of blood-pressure meds, these include weight gain, fatigue, kidney complications and, again, impotence. And despite the use of multiple drugs, the blood pressure of some patients remains poorly controlled even if the meds are taken correctly, which is a challenge for many.

So researchers took out the history books and gave surgery another look. In 2010 a team of investigators from 24 research centers, including Hpital Europen Georges-Pompidou in Paris, experimented with a less invasive procedure that does away with the scalpel and relies instead on a catheter inserted through the femoral artery and threaded to the precise spot where the relevant nerves lie buried. There a jolt of electricity can do the scalpel’s work.

Breakthrough procedures of this nature often promise great benefits but fail to deliver them. This technology proved to be a major exception. In a study published in the journal Lancet, researchers recruited 106 patients who had a baseline systolic blood pressure (the upper number) of 160 mm Hg or higher despite taking three or more antihypertensive drugs. The subjects were divided into two groups. One continued with medication alone. The other underwent kidney denervation, as the new procedure is called; no serious complications from the surgery were reported.

After six months, 84% of the patients who underwent the denervation procedure showed a reduction in systolic blood pressure of 10 mm Hg or more–compared with just a third of the other group, whose more modest improvement may have been a form of placebo response resulting from the mere fact that they participated in the study. The odds of such results’ occurring purely by chance are less than 1 in 10,000.

The news is even more encouraging than these numbers suggest. A reduction of 10 mm Hg in patients who started with a systolic reading of 160 is nice, but it still leaves them at an unhealthy 150. However, a significant share of the patients who underwent denervation–39%–did even better, with pressure dropping to normal levels. This is a profound game changer, one that sends a ripple through the entire medical community. Doctors are taught in their first months of medical school to treat hypertension with drugs. Now a mechanical solution may replace the use of meds.

The U.S. rollout of the procedure will happen with a large trial in 2012, but it should become widely available over the following two years. If you’ve got hypertension, that’s one very good reason to expect a happy new year.

Oz is vice chairman and professor of surgery at the New York Presbyterian Columbia University Medical Center, a best-selling author and the host of the nationally syndicated television talk show The Dr. Oz Show