Private practice with Dr Seth Bilazarian

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Renal-nerve denervation to combat resistant hypertension

Mar 26, 2012 17:25 EDT


With medical treatment of hypertension yielding such limited results, the promise of a safe procedure with robust results is alluring.

Read more from ACC 2012 in twitter @DrSethdb #ACC12 #RND

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Your comments
Renal-nerve denervation to combat resistant hypertension
# 1 of 5
March 26, 2012 11:35 (EDT)
Michael Wholey, MD, MBA

Thank you Seth.  

I agree the potential is very impressive for this new technique. I am very interested in the application especially in treatment of HTN and diabetes.    I am worried about restensosis with the radiofrequency.  I have recently gotten involved with a company using chemical means to denervate.

Worriesome is how far the US getting behind Europe and other countries that have access to US-made devices; we are truly four-to-five years behind because of regulations.  

Regards,

 

M Wholey

San Antonio 
# 2 of 5
March 29, 2012 11:44 (EDT)
DrSethdb

I agree the delay to even study these devices is getting longer

The US trial is just underway for this technology and the CE Mark is so long ago that we are getting one year follow-up data from singele center real life experiences in Europe so that delay is certianly concerning.  I think the FDA review process has swung to the side of safety that makes even study in cliniacl trials delayed.

thanks for posting 
# 3 of 5
March 29, 2012 06:18 (EDT)
S Nelson

Sounds like with RND the blood pressures continue to drop with time.  Any chance that they never levelize, but continue to drop forever?  Might they be too low after 10 years or 20 years?
# 4 of 5
March 29, 2012 08:08 (EDT)
DrSethdb

I think that's areally important thig for us to see as years accumulate

From a practical stnpoint these pateints are on 3 max dose anti hypertensive agents with a SBP> 160 (required for study inclusion) so 36 mmHg BP lowering on 3 max dose drugs gives you allot of room to back off therapies over time.

 If an issue it might prohibit the broader adoption to hypertensive agents who don't meet the a"resistant" criteria - we'll see.  The benefit of being so late to this as Americans is that we'll have many years of follow-up form Australian and European cohorts by the time this is device is available for use
# 5 of 5
March 30, 2012 07:07 (EDT)
DrSethdb
Greg Auclair, M.Sc. Principal Medical Science Liaison for Medtronic Cardiovascular kindly pointed out inaccuracies in my blog and I wanted to correct them here:

HTN-1 => 2 and 3-year reductions were -33/-14mmHg and -33/-19mm Hg, respectively.

There was a loss of evening / night dipping  in treated patients. 

Thanks to Greg for setting the record straight on this promising technology.

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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.