10 years of high blood pressure remained high and became an old stubborn
Auntie Chen is 60 years old and her blood pressure was found to be elevated during a medical checkup 10 years ago, reaching 210/130mmHg at the highest, and she took a variety of antihypertensive drugs, but the effect was not ideal. He had been treated in various major hospitals in Hunan Province and had been taking three or four medications, but his blood pressure still fluctuated between 160-180/90-110 mmHg.
Choosing radiofrequency ablation to treat stubborn hypertension
Under local anesthesia, Associate Professor Zhou Tao, a specialist in the Department of Cardiology, accurately punctured the femoral artery at the root of the patient’s thigh and, with the guidance of arteriography, skillfully delivered the tip of a 1.3 mm diameter radiofrequency ablation catheter to the renal artery, then precisely selected 4-6 target points according to the length and thickness of her renal artery and used 8-10 watts of energy to ablate the blood pressure located in the renal artery. Then, according to the length and thickness of her renal artery, 4-6 target sites were precisely selected and 8-10 watts of energy were used to ablate some nerve endings located in the outer membrane of the renal artery, thus selectively blocking the sympathetic nerves innervating the kidney. The procedure is abbreviated as: renal arteriogram + denervation sympathetic nerve radiofrequency ablation.
During the procedure, only the temperature of the area where the catheter comes in contact with the endothelium of the renal artery is elevated, which is usually controlled between 40-50oC, and each ablation site takes 1 minute. During the whole procedure, the temperature of the catheter and the power used are all controllable and visible. Moreover, Auntie Chen was awake during the procedure and had only slight pain, which disappeared immediately after the procedure. After the operation, Auntie Chen felt good, and the whole operation took about 40 minutes, and the blood pressure was kept at about 150/90mmHg after the operation. The treatment is minimally invasive, with fast recovery and few complications. She was able to get out of bed the next day and maintained a blood pressure of about 120/70mmHg on one antihypertensive drug Benadryl alone, and was discharged from the hospital on the third day.
On the follow-up day of March 17, she came to thank the doctor with a banner, and her blood pressure now remains around 120/70 mmHg on one antihypertensive drug, Benadryl, alone. When she learned that her blood pressure could still be lowered and that she did not need to take any more antihypertensive medication, Auntie Chen couldn’t stop smiling and said, “This is a great method! Ten years I spend nearly 50-60,000 yuan on medication, the surgery only cost more than 20,000 yuan, which is only equivalent to the cost of several years of medication, not expensive.”
So what is radiofrequency ablation?
Director Zhou said that radiofrequency ablation of the heart is an interventional treatment for tachyarrhythmias, which has a history of more than 20 years. A very thin catheter is placed into the blood vessel from the neck or the root of the thigh, and after reaching the location of the disease, radiofrequency current is released to eliminate the “lesion” at once. This method is non-invasive, minimally invasive, and has a very high success rate. It has become the first choice for the radical treatment of tachyarrhythmias, and has become a very effective treatment for atrial fibrillation with the advent of the 3-D scaler system, in addition to its mature use for the treatment of fibrillation tachycardia, atrial tachycardia, atrial flutter, and ventricular tachycardia caused by the atrioventricular bypass and the dual atrioventricular node pathway.
Radiofrequency ablation therapy has the following advantages: ① exact efficacy, high success rate and low recurrence rate; ② it can significantly improve the quality of life of patients and reduce the incidence of sudden death, heart failure and stroke; ③ small trauma and fast recovery.
More than 20 years of mature radiofrequency ablation
Director Zhou said that trans-femoral artery puncture intervention is a very mature technique, which requires no incision and generally only local anesthesia instead of general anesthesia, thus reducing the risk. It requires only a puncture in the femoral artery, which causes minimal trauma to the patient, and the patient will not suffer much during the treatment.
The operation is basically harmless to the kidney
Director Zhou said that many patients worry about whether the surgery will damage the kidneys and thus affect sexual function, but this worry is unnecessary.
The energy of radiofrequency may damage the inner lining of the renal artery to a certain extent when it destroys the nerves. However, the sympathetic nerve of the kidney and the renal artery are closely together, so radiofrequency only needs to send out a small amount of energy to achieve the purpose of treatment, and less damage to the artery, and the arterial lining has a good self-repair function.
For the effect of kidney function, this treatment will not damage the kidney function of patients, and some patients who previously had renal insufficiency, their kidney function even improved to some extent after the treatment. Hypertension itself can cause damage to the kidneys, and when the blood pressure is controlled, it will have a protective effect on the kidneys. However, the long-term effects of this treatment on kidney function need further observation before conclusions can be drawn. This aspect may not be a cause for undue concern. In patients with kidney transplants, although the sympathetic nerves are cut off, the function of the newly transplanted kidney in these patients does not seem to be significantly affected by this.
Can the nerve regenerate?
If the sympathetic nerve regenerates, wasn’t the surgery done for nothing?
Director Zhou said that the researchers did 12 months of observation during the treatment and did not find significant nerve regeneration. He said that in patients with kidney transplantation, after a certain period of time, the efferent nerves can regenerate to some extent, but the afferent nerves will not regenerate. The mechanism of hypotension of this treatment may include both removal of the efferent nerve and destruction of the afferent nerve. Therefore, even if the efferent nerves partially regenerate, there may be maintenance of the hypotensive effect.
The success rate of hypertension treatment is 80-90 percent
According to Director Tao Zhou, this new interventional treatment technique for intractable hypertension is medically known as transcatheter radiofrequency ablation denervation of renal sympathetic nerves, or RSD for short, also known as catheter-based renal sympathetic denervation, (RSD for short). The procedure is a new technique for the non-pharmacological treatment of intractable hypertension. Currently, it can only help patients with intractable hypertension to control their blood pressure, and it can help patients with intractable hypertension to get their blood pressure under control with a small amount of medication. This treatment, also called “decompensated sympathetic nerve therapy,” originated in the 1930s, was tried in the 1950s, and finally matured and applied in 2009, with a success rate of 80% to 90% for the treatment of hypertension, as confirmed in an April 2009 article in the prestigious British medical journal The Lancet. .
Mature surgery applied in new areas
Director Tao Zhou said, “In fact, radiofrequency catheter ablation is not a new technology, and has been widely used in the treatment of cardiac arrhythmias for a long time. It is only in the last two years that researchers at home and abroad have been using it for the treatment of hypertension.” Director Zhou Tao predicts that the percutaneous catheter renal artery radiofrequency ablation to remove renal sympathetic nerve method is currently mainly used in the treatment of patients with refractory hypertension. As experience is gained, the scope of treatment and indications will continue to expand. Thus, the use of this new technique will free many patients with refractory hypertension from the pain of taking large amounts of medication every day and also reduce the chance of other complications in such patients. Although the surgery is relatively safe, there are difficulties in finding the best RF treatment target and deciding how many targets to treat to achieve good results, so this type of surgery is also not yet immediately available on a large scale.
Extended reading: How to effectively prevent hypertension
(1) Regular blood pressure measurement is an effective method for early detection of symptomatic hypertension. For people with a family history of hypertension, blood pressure should be checked regularly from childhood onwards.
(2) Limit salt. Many studies have shown that salt intake is positively associated with the incidence of hypertension.
(3) Quit smoking. Smoking can make blood pressure rise, heartbeat accelerated, smoking a cigarette can sometimes make blood pressure rise 3.33kpa. long-term heavy smoking, can make small arteries continue to contract, long arterial wall degeneration, hardening, lumen narrowing, the formation of persistent hypertension.
(4) control weight. Overweight brings many side effects to the organism. The prevalence of hypertension in fat people is 2-6 times that of normal weight people, while reducing weight can normalize blood pressure.
(5) actively participate in physical exercise, relax tension. Lack of physical exercise is easy to make fat accumulation, weight gain, and blood pressure rise.
(6) Timely control of critical hypertension. When the blood pressure is between 18.7-21.3/12-12.7kpa is called critical hypertension, critical hypertension is mostly asymptomatic, but must be taken seriously.