Can Renal Denervation control Resistant Hypertension??

Hypertension is a disease affecting one billion people and is that the most typical risk factor for death throughout the globe. Approximately 90% for men and women who are non-hypertensive at 55 or 65 years will develop cardiovascular disease by the age of 80–85. World over hypertension is accountable for 51% of cerebrovascular disease and 45% of anaemia cardiovascular deaths. Unlike the popular belief that hypertension is more important for high-income countries, people in low- and middle-income countries have more than double the risk of dying of hypertension. Hypertension begins in childhood and adolescence which it contributes to the first development of disorder. The most important proportion of non-cardiovascular deaths is caused by cardiovascular diseases (48%). In terms of attributable deaths, raised blood pressure is one amongst the leading behavioural and physiological risk factor to which 13% of worldwide deaths are attributed.

In hypertensive adults, multiple irregular trials have shown that reduction of BP by antihypertensive therapy reduces cardiovascular morbidity and mortality. The magnitude of the benefit will increase with the severity of the hypertension. Based upon these observations, identifying children with hypertension and successfully treating their hypertension should have crucial impact on long-term outcomes of cardiovascular disorder.

Secondary hypertension, i.e. where a definite cause for high blood pressure is often found, is not uncommon in clinical practice and accounts for about 5% cases of hypertension. Common causes of secondary hypertension include renal disease and Reno vascular hypertension. In Asian countries, aortoarteritis is still a common cause of secondary hypertension among young patients, particularly females. Early identification and applicable treatment might considerably alter the natural history of the disease with substantial improvement in prognosis.

Whenever a patient is diagnosed with hypertension, each effort should be created to rule out any potential secondary cause for the hypertension. Suspicion of secondary hypertension should be high in early or late onset hypertension, resistant hypertension, and accelerated hypertension and in patients with markedly elevated blood pressure with severe target organ damage.

Reno-vascular hypertensions are often evaluated by non-invasive modalities like Ultrasound Doppler, MR angiography and CT angiography. If primary aldosteronism is suspected, patients should undergo screening with plasma rennin/aldosterone ratio and MRI for the detection of morphological adrenal abnormalities. Patient suspected of tumour shows a rise in plasma or urinary catechol amines; however CT and MRI are required to localize the tumours. Targeted testing should be done in all these patients to rule out any potential cause for high blood pressure. Careful and thorough clinical analysis and simple algorithms are required to avoid unnecessary tests in making the diagnosis of secondary forms of hypertensions more accurately and promptly. Correcting the cause of high blood pressure will result in cure, avoiding the need for long-term medical therapy.