Medical Breakthroughs 2013: Taming Hypertension

One of the Hudson Valley’s top medical breakthroughs in 2013



The battle against hypertension goes on. While high-tech procedures such as renal denervation -— using radio-frequency waves to disrupt overactive nerves in the kidneys, producing big dips in high blood pressure — are seeing good results, some experts say it’s still essential to focus on the basics to help boost patients’ health.

“Some of these treatments do show promise. Yet techniques such as renal denervation, and certain bariatric procedures like lap-band surgery, are not for all patients. They should only be considered a last resort, after other treatments and methods are tried first,” says Steven Yablon, M.D. of Rockland Renal Associates in West Nyack. That’s why it’s so important to try to nip problems like high blood pressure in the bud.  

Renal denervation, for instance, is considered an experimental procedure in the U.S. (it’s not yet FDA-approved), but is widely used in Europe and has been used in clinical tests here. It involves inserting a catheter into an artery near the groin, close to the kidneys, and “burning” overactive kidney nerves. The kidneys play a key role in regulating blood pressure; they help control elimination of salt and water from the body, which in turn affects blood pressure.

In one group of test patients, dangerously high blood pressure dipped by an average of 30 points after renal denervation treatment, and in some cases, denervation also appeared to improve certain heart problems, such as irregular heartbeats, according to research recently presented to the American College of Cardiology.

Other studies indicate renal denervation may also be helpful down the road for other conditions, such as diabetes and even sleep apnea. The best candidates for the procedure: certain high-risk patients with chronic, drug-resistant hypertension.

Dr. Yablon says surgeries like gastric bypass or the lap-band procedure can also be a good technique for some patients who suffer from obesity, as well as helping to improve high blood pressure and heart problems often linked to being extremely overweight.

“But if you only need to lose 20 or 30 pounds, you don’t need surgical intervention,” he says. That’s usually only recommended for patients needing to lose up to 100 pounds or more.

Dr. Yablon instead emphasizes first focusing on a lifestyle approach to controlling hypertension, diabetes, and other related health problems that are running rampant in the U.S.

“Hypertension really is a silent killer — it’s estimated that up to 70 million Americans have high blood pressure, and half don’t even know it,” he says.

The first step: Shed those excess pounds. “If a person drops just 10 percent of their body weight, it can make a difference in high blood pressure,” the doctor says. And folks carrying around extra pounds are also hiking their odds of developing type 2 diabetes. “Fat cells become more resistant to insulin; it’s not that the pancreas fails, but that it’s overloaded,” he explains; this condition can be a stepping-stone to diabetes.

“There’s simply too much mindless eating, and too many large portions,” he adds. “Fifteen years ago, the average dinner plate was nine inches around; today it’s 12 inches in diameter.”

In addition to portion control, Dr. Yablon suggests dumping the salt shaker. “I tell patients not to add any salt to meals, because there’s so much already in our processed foods. And that also means little things like not putting salt in the water when you boil pasta, not ‘just’ sprinkling it on your potatoes,” he says. “Hidden sodium is definitely a danger.”

With the average U.S. patient relying on up to three medications to control hypertension, Dr. Yablon says it makes sense to try simple measures first to keep blood pressure at healthy levels. (“Normal” is generally considered to be 130/80 or below.)

“It doesn’t have to be drastic. When it comes to losing weight, for instance, I tell patients, if it’s too hard to lose a pound a week, then aim for half a pound,” Dr. Yablon says. “Even that can mean a drop of about 26 pounds a year.”

» Return to Top Doctors 2013

 

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