Finding a Path to Treat Resistant Hypertension Through Surgery

"I looked at the blood pressure reading for a long time, thinking I must have seen it wrong."

This is a text message recently received by medical staff at Seoul National University Hospital.

A patient in their 50s with hypertension, who measured their blood pressure at home, could not put down the blood pressure monitor for a while in front of the unbelievable numbers.

The monitor screen showed '114/83 mmHg'.

It was the first time that their blood pressure, which had always hovered around 160/120 mmHg despite taking six different high blood pressure medications, came close to the normal range.

Expressing repeated gratitude to the medical staff, the patient said, "Thank you for giving me a new life."

One in three adults in South Korea suffers from hypertension.

Most people can manage their blood pressure stably through improved dietary habits, exercise, and just one or two blood pressure medications.

However, for some patients, blood pressure does not drop even when taking multiple types of blood pressure medications up to their maximum dosages.

Medically, this condition is referred to as 'resistant hypertension'.

Resistant hypertension is not simply a state of high blood pressure.

It is a high-risk group associated with a significantly increased incidence of myocardial infarction, stroke, heart failure, and chronic kidney disease.

Quite a few patients repeatedly visit emergency rooms or receive hospital treatment as their blood pressure surges to 180–200 mmHg or higher.

For such patients who are difficult to treat with conventional medication alone, 'renal denervation' (RDN) is drawing attention as a new treatment method.

The kidneys are not simply organs that produce urine.

They are core organs that regulate blood pressure in the body.

Sympathetic nerves that raise blood pressure are distributed like a spiderweb around the kidneys. When these nerves become excessively active, blood vessels constrict and sodium and water accumulate in the body, causing blood pressure to rise continuously.

Renal denervation is a treatment that lowers blood pressure by selectively blocking these excessive signals from the sympathetic nerves.

It differs in its approach from conventional medication therapy in that it does not merely lower blood pressure temporarily, but rather reduces the root cause of elevated blood pressure.

As sustained blood pressure-lowering effects and safety have been confirmed in domestic and international clinical studies, it is gaining recognition as a new treatment alternative in Europe and the United States.

Recently, moving a step beyond the conventional method of inserting a catheter into blood vessels to block nerves, 'laparoscopic renal denervation' (eRDN), which directly blocks nerves around the kidneys using laparoscopy or robots, has been developed, raising expectations for enhanced therapeutic efficacy.

Actual treatment cases of laparoscopic renal denervation are impressive.

A 50-year-old female patient experienced blood pressure surges exceeding 200/120 mmHg despite taking seven antihypertensive medications.

She had visited the emergency room multiple times due to hypertensive crises and had to undergo repeated hospitalizations.

However, the situation changed completely after she underwent laparoscopic renal denervation.

Her blood pressure stabilized rapidly after the procedure, improving to the point where she stopped taking all blood pressure medications by the 6th month.

Now, one year later, she maintains normal blood pressure while taking only two types of blood pressure medications.

Trips to the emergency room have disappeared, and she is continuing her daily life normally.

Another case is even more surprising.

A 19-year-old male patient had been taking six blood pressure medications since a young age, but his blood pressure remained uncontrolled.

With many family members suffering from strokes and heart diseases due to hypertension, he had to live with lifelong fears of severe complications.

One year after receiving laparoscopic renal denervation through a clinical trial, his blood pressure is stably maintained with only two types of medication, and his anxiety regarding cardiovascular and cerebrovascular diseases has significantly decreased.

Such cases would have been hard to imagine in the past.

This is because adding another blood pressure medication or increasing the dosage was almost the only available option for doctors treating patients with resistant hypertension.

Furthermore, laparoscopic renal denervation is noted for minimizing incision sites, resulting in almost no complications or side effects, and patients do not complain of pain or discomfort.

Professor Jung Chang-wook of the Department of Urology at Seoul National University Hospital, who developed renal denervation, stated, "Blood pressure is not just a number, but a vital indicator protecting the heart, brain, and kidneys. Particularly for patients whose blood pressure is not controlled despite taking multiple types of blood pressure medications, a new treatment option was desperately needed."

Professor Jung founded the healthcare company DeepQure in 2019 and is conducting clinical trials of laparoscopy-based renal denervation domestically and internationally.

Domestic clinical trials are in the final stages, and in the United States, approval has been obtained from the Food and Drug Administration (FDA) with clinical trials underway at five major medical institutions, including Stanford University Hospital, Mayo Clinic, UC Irvine, the University of Florida, and Henry Ford Hospital.

In the domestic laparoscopic clinical trial, tracking nine patients for 12 months showed that the average systolic blood pressure decreased by an average of 51 mmHg, dropping from 165 mmHg before surgery to 114 mmHg after surgery.

The research team explained that they confirmed a very significant blood pressure-lowering effect compared to previously published catheter-based renal denervation studies.

Professor Jung stated, "Candidates for surgical treatment are determined through careful evaluation among resistant hypertension patients whose blood pressure is not controlled despite lifestyle improvements and sufficient use of multiple types of antihypertensive drugs. For resistant hypertension patients who had no clear alternatives other than increasing blood pressure medications, treatments targeting the very cause of elevated blood pressure are now becoming a reality."

(Photo: Provided by Yonhap News TV, Yonhap News)
※ Please note: This article was translated by AI and may contain errors.