Even as the incidence of hypertension increases in India, doctors are contemplating the use of "sympathetic renal denervation", a procedure used to treat resistant systemic hypertension.
Resistant hypertension is when high blood pressure cannot be controlled even after using three to four medicines, one of which has to be a diuretic (a medicine that increases the volume of urine excreted). It is still rare but the incidence needs to be quantified, doctors said.
"The procedure involves putting a catheter inside the renal arteries and giving short currents to burn off sympathetic nerve terminals outside the arteries at multiple places. It has no side effects and reduces blood pressure over a few months. It has been used in the west and we are thinking of starting soon," said Dr Akshay Mehta, consultant cardiologist at Nanavati Hospital. The procedure needs approval from the Indian Food and Drug Administration and hospitals also need to procure the machines, he said.
"It started recently and we are waiting for it to stabilise. But one must examine all the secondary causes and try to change medication timings before terming HBP as resistant hypertension," said Dr Rawat.
Although this procedure is meant for relatively uncommon type of hypertension, doctors are using different methods to monitor blood pressure among people, like self-examination and ambulatory methods.
Doctors are also adopting diagnosis through ambulatory blood pressure, which involves periodic monitoring of BP for 24 hours. "Sometimes people show high blood pressure at clinics because of anxiety. That may lead to inaccurate diagnosis. Either they could check at home or do an ambulatory check-up so that exact pattern is documented," said Dr Mehta. "Through this we can observe how BP behaves in natural settings, day and night." Ambulatory care is a type of medical care which is provided to patients who do not need to be admitted to a hospital for treatment.
Patients, who may have episodic (at certain times in the day, say during office hours), borderline (when the BP is not very high but could still lead to complications) hypertension, can benefit by his method, doctors said.
"Now there are machines to check blood pressure at home, ambulatory check, better drugs and technologies such as renal denervation for extreme cases. But what works is weight loss, reduction in salt and alcohol intake, and daily exercises such as walking and swimming," said Dr Brian Lobo, consultant cardiologist at Holy Family Hospital.