Marshall Evans may be retired, but he’s always on the clock — he repairs them for fun. He also spends time refurbishing classic cars.
But for years, Evans struggled to enjoy the pleasure of restoring those antiques. Medication alone failed to lower his blood pressure, which often spiked without warning.
“Anytime it got above 200, I would get a throbbing, terrible headache,” said Evans, 71. “It took a lot out of me, and the biggest thing I worried about was a stroke. I’d wonder, ‘Is this going to be the one?’”
When nothing helped, Evans’ healthcare team suggested renal denervation (RDN), a new, minimally invasive outpatient procedure that can reduce blood pressure long term and offer a better quality of life. Evans was the first patient to receive the procedure, approved by the FDA in November 2023, at Novant Health New Hanover Regional Medical Center in Wilmington. The procedure was performed by interventional cardiologist Dr. Sunil Iyer.
“The team made me feel at ease,” Evans said. “I trusted them.”
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The kidney connection
You may be surprised to learn that hypertension has more to do with the kidneys than the heart. In fact, the kidneys are the key organ system in charge of regulating blood pressure.
“The heart is more of a bystander that gets all the credit,” said interventional cardiologist Dr. Brian Kelley, who regularly performs the renal denervation procedure at Novant Health New Hanover Regional Medical Center. “But the kidneys are the real source of what causes hypertension in the first place.”
The kidneys and the brain are constantly talking through nerves that run along the arteries and lead to the kidneys. And sometimes the nerves surrounding the kidneys send too many signals.
Those overactive nerves can trigger a chain reaction throughout the body. They signal the kidneys to retain more salt and water, narrow blood vessels and release hormones that raise blood pressure. Over time, that constant stimulation can make hypertension difficult to control, even for people taking multiple medications.
Renal denervation is designed to interrupt those signals. It targets the nerves surrounding the renal arteries, reducing their ability to send messages that contribute to high blood pressure. Because the treatment addresses one of the underlying drivers of hypertension, it can provide a lasting reduction in blood pressure for some patients.
The procedure and the recovery
During the renal denervation procedure, the surgeon inserts a thin, flexible tube through a small incision in the patient's groin and into the renal artery, the main blood vessel that carries blood to the kidney.
“The procedure is similar to what we do with balloons and stents in the heart, but focused on a different place in the body,” Kelley said.
Ultrasound pulses take the pressure off the arteries by burning surrounding fat and calming those nerves.
The procedure typically takes less than an hour, and most people go home the same day, then return to their normal activities within a few days. While RDN is not a cure for hypertension, studies have shown that it can help lower blood pressure around the clock, including during nighttime hours when elevated blood pressure often goes unnoticed.
Evans noticed a significant difference about six weeks after the renal denervation procedure, and his blood pressure continued to drop over the months that followed. It moved from above 200 (a hypertensive crisis) into a range that is manageable with medication. The best part? No more debilitating headaches, freeing him from the dread of when one might strike.
Evans, a great-grandfather who has called Bolivia, North Carolina, home with his wife, Debbie, for more than 30 years, said he can’t wait to take on his next renovation project: a ’68 Camaro.
“I’ve got my energy and my mindset back,” he said.
FAQs
Renal denervation (RDN) is a minimally invasive procedure used to help lower blood pressure when medications are ineffective. During the procedure, a catheter is inserted into the renal arteries to address overactive nerves surrounding the kidneys. These nerves contribute to high blood pressure by signaling the body to retain salt and water and constrict blood vessels.
Renal denervation may be an option for adults with uncontrolled or resistant hypertension when medication alone has failed to lower blood pressure. A physician can determine whether the procedure is appropriate based on a patient's history with medication for high blood pressure.
Most patients return home the same day. The procedure typically takes a couple of hours, with many patients back to normal activity within a few days.
Renal denervation is not a cure for hypertension and does not necessarily eliminate the need for medication. The procedure can help lower blood pressure for several years, with some patients requiring fewer medications.
Yes. The FDA approved renal denervation as a hypertension treatment in 2023.
