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Surgery for high blood pressure
Published on: Tuesday, September 19, 2023
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Surgery for high blood pressure
In Malaysia, where an estimated 35.3 per cent of adults over 18 years have high blood pressure, many would rather endure the ailment than take medicine to control it. RDN may offer more persistent control of blood for those patients who go off medical therapy. Dr Chu Chong Mow (left)
HIGH blood pressure or hypertension is one of the most common medical conditions worldwide.

It is a serious condition. The World Health Organisation (WHO) estimates that 12.8 per cent of all death in the world is caused by high blood pressure.

It is estimated 1.4 billion people worldwide have hypertension. High blood pressure significantly increased the risk of heart, brain and other diseases.

In Malaysia, it is estimated 35.3 per cent of adult 18 years and above have high blood pressure.

There is no significant gender difference observed. It is more common in the elderly and it is estimated that among those aged 70-74 years-old 75.4 per cent has high blood pressure.

Historically, hypertension was called “hard pulse disease”.

Before the modern therapeutic approach, the treatment of “hard pulse disease” consisted in reducing the quantity of blood by bloodletting or the application of leeches.

These had been advocated by The Yellow Emperor of China, Cornelius Celsius, Galen and Hippocrates. 

In the 19th and 20th centuries, before effective pharmacological treatment for hypertension became possible, three treatment modalities were used, all with numerous side-effects: strict sodium restriction, sympathectomy (surgical resection of parts of the sympathetic nervous system) and pyrogen therapy (injection of substances that cause a fever, indirectly reducing blood pressure). 

With the advancement of modern medicine many chemicals for hypertension have been invented.

These newer blood pressure medicine has dramatically reduced the side effect and complication of treatment and render blood pressure under control effectively.

Medical therapy has been the traditional backbone therapy for high blood pressure since 1950. There are more than hundreds of medications that can be used for high blood pressure. 

Blood pressure of more than 140/90 mmHg is considered significantly elevated.

Blood pressure medication has been shown to benefit these groups of patients, therefore lowering their long-term risk of cardiovascular disease such as heart attack, stroke and kidney failure.

Despite taking medications, it is important that the blood pressure to be regularly checked to make sure it reaches the appropriate level. 

The role of the physician here is to ensure the blood pressure is controlled appropriately, based on the individual cardiovascular risk.

In some groups of patients, despite the best medical care and treatment the blood pressure will not be able to reach the appropriate level.

In such situations, the physician will usually discuss with a modern and effective treatment for blood pressure. 

Renal Denervation (RDN) is a new and innovative procedure that can effectively help patients with hypertension.

It has already been applied in 10,000 real-world cases.

Renal denervation applies the concept of sympathectomy that has been used since more than a century ago.

Traditionally, this method of hypertension treatment involves surgical excision of sympathethic nervous systems that are responsible for hypertension.

This is a very effective way of permanently reducing blood pressure. 

The modern medicine conceptualises a minimally invasive procedure with effective efficacy.

It has been determined that kidneys play a central role in helping your body regulate arterial blood pressure.

High blood pressure occurs when the specific nerves that lead to the kidney become overactive. 

The RDN procedure works by delivering energy to these overactive nerves to decrease their activity which will subsequently help reduce your blood pressure levels. 

The effect has been shown in a large study to be effective and permanent. It has been shown to lower the risk of further damage to the heart, kidney and blood vessels.

In the long term, use of blood pressure medication can be reduced as well.

The RND procedure usually takes around one to two hours.

The procedure involves inserting a small thin tube from the groin into the kidney artery.

From the thin tube the energy is delivered to the overactive nerve to regulate and decrease activity. 

This is performed for both kidneys to ensure all the overactive nerves are treated. Once the treatment is completed, the tube is removed, leaving nothing behind.

The procedure can be done only through local anaesthesia. Occasional sedation maybe needed.

This procedure has been shown to be safe and effective. The risk of the procedure is extremely low.

There is no long term side effect known from this procedure. 

There are lots of misconceptions about blood pressure measurements and treatments.

In the local Malaysian context, many still undermine the importance of blood pressure control.

Hypertension is usually asymptomatic; many have difficulty accepting the diagnosis because they do not feel it. 

Accepting the diagnosis will be the most important hurdle for treatment success.

Malaysians in general still believe in complimentary medicine, traditional medication and homeopathy. 

There is a lack of trust in modern medicine as many see it as being “kidney or liver toxic”.

Many would rather endure elevated blood pressure rather than take medication.

Therefore, RDN may offer more persistent control of blood for those patients who go off medical therapy. 

The procedure is also valuable to younger patients who will be on medication longer than more senior sufferers.

RDN is an effective surgical intervention for hypertension.

It is meant to compliment medical therapy not replace it.

Perhaps soon, with newer technology and advances in medicine, a cure for hypertension may one day be found.

# This article was contributed by Dr Chu Chong Mow who is a Consultant Interventional Cardiologist & Physician at Gleneagles Hospital Kota Kinabalu.


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