Nearly half of adults in the United States have high blood pressure, and of those, only about one in four has their blood pressure under control, according to the Centers for Disease Control and Prevention.
Even more challenging, around ten million adults have high blood pressure that simply doesn’t respond well to treatment.
When you have your blood pressure taken or take it at home yourself, the numbers you’re hoping to see are 120/80.
That’s a normal blood pressure.
Jamie Pepperman, 44, had not seen those numbers in a long time.
Her blood pressure started to rise in her early 30s, and no matter what doctors tried, it kept climbing.
“It began about 10 years ago. I was having a lot of headaches, just wasn’t feeling myself,” said Pepperman. “Went to the doctors, couldn’t really tell me anything. Went for an eye appointment, regular eye appointment, and they immediately sent me to the emergency room.”
An MRI revealed Pepperman had severe swelling of her brain stem and had suffered a stroke.
“At 34 years old, it’s very disheartening to hear that I had a stroke,” remembered Pepperman. “About six months later, I had another stroke.”
Doctors couldn’t figure out what was causing her blood pressure to soar so high, and it wasn’t responding to treatment.
“It started to affect my kidneys, my kidney functions started to lower, my retinas, my vision started to get much worse than it normally would have,” said Pepperman.
Despite seeing numerous specialists, her blood pressure remained out of control.
During one video appointment with a physician --
“He had me take my blood pressure on the video appointment, and when I showed him the monitor, he immediately called 911,” said Pepperman. “They did another MRI and determined I had another stroke.”
Remember, a normal blood pressure is 120/80. Around this time, Pepperman’s was as high as 270/174.
“I lived with that high of a blood pressure as a daily normal functioning blood pressure for almost 10 years,” said Pepperman.
She was somehow surviving, but not thriving.
“My head always hurt. I didn’t have any energy. I noticed that I was getting short of breath,” said Pepperman. “I was exhausted. It completely decreased my quality of life.”
Pepperman was on 10 medications for her blood pressure, and it wasn’t getting better.
She decided to switch specialists and got a referral to Corewell Health William Beaumont University Hospital in Royal Oak. https://corewellhealth.org/care-and-specialties/heart-and-vascular
Dr. Rob Safian is an interventional cardiologist there and the founder and director of the Center for Innovation and Research in Cardiovascular Disease.
https://providers.corewellhealth.org/provider/robert-d-safian/3189376?unified=safian&categories=clinical_keywords%2Cspecialties%2Cprovider_name%2Cprimary_care&sort=relevance%2Cnetworks%2Cavailability_density_best&from=search-list
“I was shocked,” said Safian. “I really couldn’t believe that she was walking around with a blood pressure of 230. I mean, we would normally hospitalize people for doing that.”
Safian immediately thought Pepperman would be a good candidate for a procedure called renal denervation.
At the time, it was approved by the FDA, but it was still going through steps to make it commercially available.
“We were really anxious to be able to offer this to her. And we had conversations with her insurance payer, and it was a matter of negotiation, cajoling, and educating,” said Safian.
It took two months of persistence, but they succeeded.
“The day he called me to tell me that the surgery was covered, I was sitting at my desk working, and I just started crying. I broke down and just started crying,” said Pepperman.
So how does renal denervation work?
“The way blood pressure in the body is regulated is through nerve connections between the kidney and the brain,” explained Safian. “If you can interrupt those nerve signals between the kidney in the brain, then you can lower the blood pressure.”
That’s true no matter what’s causing the elevated blood pressure.
Renal denervation is a minimally invasive technique that targets specific nerves near the kidneys that can become overactive, leading to high blood pressure.
The procedure works by delivering radiofrequency energy to these overactive nerves to decrease their activity.
“You deliver the denervation catheter in such a way that it heats the wall of the artery, which then gets transmitted to nerves that surround the artery,” said Safian. “We try to treat all of the main portions of the kidney artery, all of the main branches and sub-branches in vessels that range from about three millimeters in diameter up to eight millimeters in diameter. And then we’re done with the right kidney, then we just repeat the entire process on the left kidney. The whole procedure takes about an hour or so,” explained Safian.
It can take up to four months to see full improvement, but Pepperman’s results surprised even her doctor.
“On the first day follow-up, her blood pressure was 135 over 75, and I thought it was a mistake,” said Safian. “I talked to my nurses, I went in with my blood pressure cuff, and I took the blood pressure myself, and that’s what her blood pressure was.”
“For three and a half months, it’s been consistently within normal range,” said Pepperman. “Now I’m on a total of four medications for my blood pressure, when three months ago I was on ten. I have more energy, and I’m happier. I just, I look forward to every day.”
“I can’t tell you how thrilled all of us are,” said Safian. “All of the doctors and the nurses who’ve been involved in her care are absolutely thrilled that she has had this kind of dramatic response in her blood pressure. And she really has her life back.”
“I truly feel like they saved my life,” said Pepperman. “To be kept telling ‘No, no, no,’ and just be put on more medications, that’s not comfortable. So this team of doctors that helped me get to this point, I owe my life to. I feel like they gave me a new life.”
Because the procedure is relatively new, doctors don’t know for sure how long the results will last, but follow-up studies have found sustained improvement for up to seven years in some patients.
The best candidates for renal denervation are people with high blood pressure that isn’t controlled with three or more medications.
Since Pepperman’s procedure, Corewell Health says Medicare and most private insurers now cover renal denervation if patients meet the criteria.
To learn more about renal denervation, click here.
https://www.webmd.com/hypertension-high-blood-pressure/can-renal-denervation-replace-blood-pressure-meds
To read more about Pepperman’s journey, click here.
https://corewellhealth.org/love-your-heart/jamie