Advanced treatment for hypertension

Patients with hypertension medication now have a new treatment option at Novant Health: renal denervation. Novant Health is partnering with referring physicians to offer this FDA-approved procedure to reduce patient reliance on hypertension medication.

Nearly of patients have refractory hypertension. Additionally, those taking three or more prescription medications might struggle with side effects such as shortness of breath and fatigue. That’s why Novant Health’s interventional cardiologists are offering renal denervation from the Triad to the coast. The first renal denervation systems were FDA-approved in 2023 as an adjunctive therapy for patients with inadequately controlled blood pressure despite medications and lifestyle modifications.

“Renal denervation offers a minimally invasive option to help improve blood pressure control in patients with treatment-resistant hypertension while potentially reducing reliance on additional medications,” said Dr. Sunil Iyer, an interventional cardiology with Novant Health Heart & Vascular in Wilmington.

As of October 2025, renal denervation procedures are covered by Medicare and Medicaid.

How does renal denervation work?

In short, this minimally invasive outpatient procedure uses ultrasound energy to ablate renal nerves that contribute to high blood pressure. Interventional cardiologists make a small incision in the groin to insert a catheter into the femoral artery in order to deliver the ultrasound vibrations, heating the tissue around the nerves. This one-to-two-hour process disrupts nerve activity and reduces the pressure put on arteries during heart contractions.

“We’re addressing a small number of sympathetic nerves around the kidneys to safely and effectively reduce hypertension and lower the risk of heart attack and stroke,” said Dr. Nizar Noureddine, an interventional cardiologist with Novant Health Cardiology - Kimel Park Main.

“The approved systems and techniques achieve this without damaging the arteries or kidneys,” said Dr, Noureddine. “While risks are low, they do include bleeding, bruising, or infection at the catheter insertion site.” Risks also, of course, include lack of response to the therapy.

Post-op, most patients can resume normal activities within 48-72 hours while continuing their usual antihypertensive medications and follow-up blood pressure monitoring.

How effective is renal denervation?

Studies have shown statistically significant reductions in blood pressure for many patients with uncontrolled hypertension. One clinical trial showed a consistent reduction in systolic blood pressure of −8 mmHg from two months to 36 months. Another showed a reduction of −12.1 mmHg. These reductions appear durable over several years and are observed across different device platforms.

A major barrier to broader adoption of renal denervation is the multifactorial nature of hypertension, where genetics, environment, lifestyle, and behavior contribute and many patients already receive complex multidrug regimens.

“It’s important for referring physicians to rule out pseudoresistance to treatment – such as nonadherence, secondary hypertension and white-coat effects – prior to referral,” said Dr. Iyer.

The procedure may also be a good option for patients who cannot tolerate enough antihypertensive medication to effectively manage hypertension.

Candidate selection is often a collaborative effort between general practitioners and interventional cardiologists. “General practitioners help confirm true resistant hypertension while we determine procedural suitability and complete any necessary imaging,” said Dr. Iyer “We work together to align patient education and follow-up so renal denervation is integrated safely and effectively into the patient’s broader hypertension management.”

Patients are generally excluded if they have significant renal pathology or unfavorable renal artery anatomy, including impaired kidney function, and cystic or tumorous renal disease.

“Renal denervation gives us a valuable, evidence-based tool to support patients whose blood pressure remains difficult to control despite appropriate therapy,” said Dr. Noureddine. “By integrating this option thoughtfully into our hypertension management strategies, we may help more patients achieve sustained blood pressure improvement and reduce long-term cardiovascular risk.”