None of the drugs doctors prescribed controlled Michael Garrity’s dangerously high blood pressure – until they cut some of the nerves to his kidneys. If it sounds strange, well, the kidneys help control blood pressure through signals from certain nerves. The new treatment blocks overactive kidney nerves.
“My blood pressure would go up and I would feel short of breath and tired, and now that doesn’t happen,” said Garrity, 62, of Needham, Massachusetts. He still takes medication but at a lower dose, with his blood pressure back to normal for the first time in years. “I’m thrilled.” Nearly half of U.S. adults have high blood pressure, which poses a greater risk of heart attack, stroke, kidney failure, even dementia. Many people do not realize they have high blood pressure until it causes serious damage.
“Know your blood pressure, know the numbers,” emphasizes Dr. Randy Zusman of Massachusetts General Hospital, who specializes in the most difficult cases to treat and advises people who think they’re fine, less Get an annual checkup done at least.
And only a small number of patients have their high blood pressure well controlled, meaning new strategies are needed. The Food and Drug Administration approved the “kidney prevention” option about a year ago based on studies showing modest benefits in patients whose blood pressure remains high despite multiple medications.
Now, after the American Heart Association recently deemed it promising, some hospitals, including Mass General Brigham, are offering it cautiously as they figure out who are good candidates — and whether their insurance will cover the thousands of dollars worth of cost. Will cover invasive procedures.
What is high blood pressure?
Two numbers describe blood pressure. The peak, “systolic” pressure, is the force that blood exerts on the walls of the arteries as it is pumped by the heart. The lower “diastolic” number measures the same pressure but between heartbeats.
Normal is less than 120 to less than 80. Blood pressure naturally fluctuates throughout the day, being higher when you are physically active or stressed. But when it stays high — consistently from 130 to 80 or higher, according to the latest guidelines — it hardens the arteries and the heart has to work harder.
how to measure blood pressure
There is no need to go to the doctor in this. Pharmacies and sometimes libraries also offer screening, and people can use monitors at home. To avoid falsely high readings, the American Medical Association suggests: Sit quietly with feet on the floor, not crossed legs. Place the cuff on the bare arm, not over clothing. Don’t let the hand hang – keep it on the table.
Medicines are not the only way to treat high blood pressure
Lifestyle changes are the first step, especially for healthy people. The guidelines urge taking steps to lose weight, exercise, eat more fruits and vegetables, limit salt and alcohol, and deal with stress. Medication becomes necessary when high blood pressure reaches more than 90 to 140. The average patient needs two or three medications, sometimes more, to maintain a healthy life, Zusman said.
But the high blood pressure that Garrity has struggled with since he was 20 is treatment-resistant. Despite taking four to six medications, as well as a strict diet and exercise, his blood pressure regularly rose from 100 to 150 or worse.
What is renal inhibition?
The doctor inserts a small catheter or tube through the blood vessels to reach the kidneys, and then delivers ultrasound or radiofrequency energy. Those pulses pass through the renal arteries to selectively target nearby veins, said Dr. Joseph Garasik, a Mass General interventional cardiologist who performed Garrity’s procedure. It takes about an hour.
Although already being used in other countries, a major US trial of the kidney strain failed nearly a decade ago, prompting changes before researchers could try again. In November 2023, the FDA approved two catheter systems from Recor Medical and Medtronic. It is not a cure – and some patients do not get any benefit. But Garasik said several studies have shown an average drop in blood pressure of 8 to 10 points, which is a modest but significant improvement. Some people, like Garrity, see a big decline, enough to gradually taper off the medications.
The FDA approved the procedure as safe for carefully selected patients — for example, it was not tested in people with kidney disease or narrowed arteries. And the study only lasted a few years, not enough time to tell whether the nerves might eventually regenerate. The American Heart Association’s guidance urges prospective patients and experienced doctors to have a “thoughtful and informed discussion” to decide who is a good candidate.
