What is the criteria for the use of renal denervation in people with hypertension?
KUALA LUMPUR, 11 January 2022 – The Malaysian Renal Nerve Denervation Working Group (MyRDN), a collaboration between the Malaysia Society of Hypertension and the National Heart Association of Malaysia, previewed its consensus paper on renal denervation publicly for the first time today. The paper provides recommendations and guidelines for healthcare professionals with regards to the use of this procedure in the treatment of people with hypertension.
Professor Datin Dr Chia Yook Chin, co-chair of MyRDN and Immediate Past President of the Malaysia Society of Hypertension, said: “Hypertension is a serious problem in our country, with three in 10 Malaysians having high blood pressure, but only half of them being aware that they have this ‘silent’ condition.
“On top of that, while 90% of those who are aware they have hypertension are on medication, only half have their blood pressure under proper control. This means that around 1.4 million Malaysians have uncontrolled high blood pressure – whether it’s because they are unaware of their condition or are not on optimal therapy – exposing them to complications like heart attacks, stroke and other heart diseases.”
The senior consultant family physician added: “Renal denervation may prove to be of help in treating certain types of hypertensive patients, for example, those who have resistant hypertension, are consistently unable to adhere to their medication despite counselling and advice, or are on multiple medications for various co-morbid diseases.”
Renal denervation is a minimally-invasive procedure where radiofrequency waves are targeted at the renal (kidney) sympathetic nerves in order to reduce their activity, which contributes to hypertension. It is carried out under local anaesthesia and sedation, with patients usually allowed to go home the day after the procedure.
Preliminary results from the ongoing SPYRAL HTN-ON MED clinical trial showed that patients with uncontrolled hypertension despite being on one to three antihypertensive drugs, experienced a 9.0 mmHg decrease in systolic blood pressure and a 6.0 mmHg decrease in diastolic blood pressure (measured continuously over 24 hours via ambulatory monitoring) six months after undergoing the procedure. In comparison, patients who underwent a sham procedure (i.e. a renal angiogram, rather than renal denervation) experienced a 1.6 mmHg decrease in systolic blood pressure and a 1.9 mmHg decrease in diastolic blood pressure. The full results of the trial are expected to be announced in late 2022.
Dr Ong Tiong Kiam, co-chair of MyRDN and council member of the National Heart Association of Malaysia, said: “Renal denervation is a relatively simple and safe procedure, but it is important that the patient’s expectations of the outcome be managed.
“The drop in blood pressure will be gradual over a number of months and the patient will still need to continue taking their regular medications immediately after the procedure. In the long run, the procedure will enable most patients to better control their blood pressure, although it is unlikely they will be able to completely stop their antihypertensive drugs. The main benefit of the procedure is a decrease in the risk of organ damage and heart disease, like heart attacks and stroke, due to uncontrolled hypertension.”
The consultant cardiologist and head of Sarawak General Hospital’s Department of Cardiology added: “Ideally, renal denervation should be offered early in the treatment of patients who fit the recommended criteria for the procedure. However, it is important to note that lifestyle modification and antihypertensive drugs are still the mainstays of treating high blood pressure. Renal denervation serves as an adjunct treatment for the sustained lowering of blood pressure in patients who met the criteria for the procedure.”
Prof Datin Dr Chia and Dr Ong were joined at the public announcement by National Heart Institute senior consultant cardiologist Dato’ Seri Dr Azhari Rosman, National Heart Association Malaysia President Dr Alan Fong Yean Yip and National Heart Association Malaysia Immediate Past President Prof Dr Wan Azman Wan Ahmad, who shared their knowledge and expertise on hypertension and renal denervation during a panel discussion and Q&A session with the media.