SMOKINCHOICES (and other musings)

November 20, 2012

Trials – new HBP treatment


High blood pressure might get a new foe


About 1 in 10 people with high blood pressure finds inadequate help from medications, even when on a half-dozen or more pills.

Drug-resistant hypertension has long confounded doctors and frustrated patients, who live with side effects from medicines that don’t entirely alleviate the problem.

Researchers at 87 centers throughout the country are testing a potential fix that approaches the problem in a novel way. Instead of going after high blood pressure with medicine, they are going after the nerves that carry messages from the brain to the kidneys and back.

Blood pressure is controlled in large part by the sympathetic nervous system, which includes the brain, heart, kidneys and blood vessels. In people with hypertension, the renal nerves are hyperactive.

FRED SQUILLANTE DISPATCH    Study enrollee Glenn Loper of Marion undergoes a procedure performed by Dr. Mitchell Silver, an interventional cardiologist leading the study at Riverside Methodist Hospital.

Using a catheter inserted through the groin, doctors are essentially killing the nerves in the renal artery, with the goal of eliminating messages that throw blood pressure out of whack. The treatment is widely available in Europe and Australia.

In the current U.S. study, half the patients get the treatment; the other half don’t. The experiment eventually will involve 500 patients, including some treated at Riverside Methodist Hospital, Ohio State University’s Wexner Medical Center and four other sites in Ohio.

Uncontrolled high blood pressure is a big burden on the health-care system and is hard on patients, said Dr. Mitchell Silver, an interventional cardiologist who is leading the study at Riverside, where two patients have been enrolled. “It’s a big quality-of-life issue,” he said.

Patients are likely to have more-intense side effects as doctors increase the dosage and number of medications to try to lower dangerously high blood pressure, Silver said. Side effects can include fatigue, weakness, depression and dizziness. Men might experience impotence.

Silver and others involved in the research hope that the trial has positive results and will give patients another option.

During the procedure, low-power ultrasound is applied to the nerve endings to shut them off, he said. The process takes about 20 minutes per artery.

The device maker behind this trial is Medtronic, but several other companies are working on similar concepts.

Dr. Christopher Valentine, a nephrologist at Ohio State, said the medical center has enrolled seven patients in the study.

Earlier studies of the experimental treatment have shown a drop in systolic blood pressure — the top number — of 20 to 30 points, he said.

Research has shown no harm from inactivating those nerves, Valentine said. Specifically, it has not caused problems for the kidneys, nor has it affected electrolyte levels.

Patients who are candidates for the study have systolic blood pressure of 160 or higher that is not reduced by medications.

About 30 percent of patients aren’t good candidates because they lack a long enough stretch of renal artery (without vessels branching off) to work on, Silver said.

Glenn Loper, a 54-year-old from Marion, was the second to enroll in the study at Riverside last week. He learned he had high blood pressure when he was 14 years old, and he has had problems with it for most of his adult life.

Loper said he had been researching the procedure for more than a year when he learned it was being studied in Ohio.

He won’t know for a while whether he was one of the patients who got the experimental treatment (everyone undergoes some of the procedure so that they won’t know whether they received the treatment), but he’s hopeful he will be. Loper takes eight blood-pressure medications yet has a systolic blood pressure higher than 200.

“I don’t even like to take aspirin,” he said.

(Looks promising for intractable cases.   Jan  )


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