Renal denervation receives recommendation by working group | Multidisciplinary

The Malaysian Renal Nerve Denervation Working Group (MyRDN), a partnership between the Malaysia Society of Hypertension (MSH) and the National Heart Association of Malaysia (NHAM), recently previewed their consensus document on renal denervation. The paper outlines recommendations and guidelines for healthcare professionals regarding the use of this procedure in the treatment of people with hypertension.

“Hypertension is a serious problem in our country, with 3 in 10 Malaysians having high blood pressure, but only half of them being aware that they have this ‘silent’ condition,” said Professor Datin Dr Chia Yook Chin, co-chair of MyRDN, during a media briefing.

Chia, who is also immediate past president of MSH, added: “On top of that, while 90 percent 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.” [National Health and Morbidity Survey (NHMS) 2019. Available at http://iku.gov.my/images/IKU/Document/REPORT/NHMS2019/Infographic_Booklet_NHMS_2019-English.pdf Accessed on 13 January 2022]

Also present at the media briefing, Dr Ong Tiong Kiam, co-chair of MyRDN and council member of NHAM, noted that renal denervation (RDN) was a relatively easy and safe procedure but cautioned doctors to manage patient expectations [as it may not preclude the need for continued pharmacotherapy].

Ong said: “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.”

RDN, said Ong, should ideally be offered early in the treatment of patients who fit the recommended criteria for the procedure. These are the patients who stand to gain the most from RDN. However, he noted the importance of reminding patients that lifestyle modification and antihypertensive medication remain the mainstay of blood pressure treatment. “Renal denervation [only] serves as an adjunct treatment for the sustained lowering of blood pressure in patients who met the criteria for the procedure.”

Dato’ Seri Dr Azhari Rosman, senior consultant cardiologist, National Heart Institute (IJN); Dr Alan Fong Yean Yip, president of NHAM, and Professor Dr Wan Azman Wan Ahmad, immediate past president of NHAM, also participated in the media briefing.

About RDN
Renal denervation is a minimally invasive procedure where radiofrequency waves are targeted at the renal sympathetic nerves to destroy small parts of it, and thus reduce their activity. The overactivity of the renal sympathetic nerves is thought to contribute to hypertension. RDN is done under local anaesthesia and sedation, and patients are usually discharged the day after.

Early results from the ongoing SPYRAL HTN-ON MED* clinical trial showed that patients with uncontrolled hypertension experienced a 9.0 mmHg drop in systolic blood pressure and a 6.0 mmHg drop in diastolic blood pressure (measured continuously over 24 hours via ambulatory monitoring) 6 months after undergoing RDN procedure. These are patients whose blood pressure was uncontrolled despite being on one to three antihypertensive drugs.

In comparison, patients who underwent a sham procedure, such as renal angiogram, experienced a 1.6 mmHg drop in systolic blood pressure and a 1.9 mmHg drop in diastolic blood pressure. The full results of the trial are expected in late 2022.

*SPYRAL HTN-ON MED: Global Clinical Study of Renal Denervation With the Symplicity Spyral™ Multi-electrode Renal Denervation System in Patients With Uncontrolled Hypertension on Standard Medical Therapy

Resources

Hypertension Management.pdf

Updates On Clinical Guidelines For Managing Patients With Hypertension