How renal sympathetic denervation helps patients suffering from hypertension resistant to drug treatment?
The theory behind renal denervation is that in most patients there is a constant exchange of information via nerve impulses between the kidneys and the brain. Some of these nerves are a part of the vascular tone regulation and during certain changes they can 'ask' for high blood pressure. Renal denervation is the use of a catheter placed in the artery feeding the kidney, which delivers heat energy and destroys the affected nerves thus severing the connection between the kidney sympathetic system and the brain. Initially, there were hopes that the method will benefit a significant number of patients, as few people enjoy taking the same medicine for 15-20 years.
However, renal denervation doesn't always work, so the efforts were targeted to patients resistant to hypertension drugs. Today we know that in order for the therapy to help, these patients should be relatively young, under 65 years of age, and should have relatively elastic aorta and blood vessels. The research is now channeled to identifying the exact group where renal denervation will have best results, and on new devices for more effective and quick destruction of the targeted nerves.
As one of the few specialists in Bulgaria on pulmonary hypertension, can you explain what the condition is?
Pulmonary hypertension is a syndrome caused by increasement of the pressure in the pulmonary artery. It is relatively rare, and in Bulgaria there are only three specialised centres for treatment: two in Sofia and one in Varna. The medicines used in its treatment are very specific, but there is a progress in the field. Not that long ago patients with pulmonary hypertension were seemed as doomed.
To what extent cardiovascular diseases are genetically predisposed?
The answer is a moving target, as genetics are making fast progress and, say, 10 years from now, a discovery could be made explaining a disease that we now think of mainly the result of bad lifestyle choices as actually genetically predisposed. It is hard to say definitely. Serious diseases like atherosclerosis and hypertension are though of as both hereditary and the result of unhealthy habits. Over 60 genetical markers have been identified as heart attack triggers, with the number likely to rise. We cannot change genetics, but we can use the information they give us and advice the patient to start taking medicines in advance, change his lifestyle, attend early screenings, etc. My practice, however, shows that patients are more prone to start taking drugs instead of quitting smoking and increase their physical activity.
What are the most fascinating discoveries in modern cardiology for you?
In the past 10 years we have witnessed two quiet revolutions. The first is in imaging. Today a 15-minute scan can provide the patient with a complete map of his heart: the cavities, the vessels, the blood supply. This can be crucial for choosing the right treatment, although in this respect, clinical treatment is lagging behind. We have now more information than we can process. Biomarkers are the second revolution. These are molecules whose very presence is indicative if, for example, the patient is having heart failure. This ability is extremely helpful for colleagues in urgency units who work under pressure and have little time to decide if the patient is having a heart or a pulmonary problem.
Cardiology Clinic at St Anna University Hospital for Active Treatment
Sofia, 1 Dimitar Mollov St
phone: 02 975 9111