Interview
Interview with PD Dr. med Karl-Philipp Rommel, Senior Consultant in Cardiology at the Mainz University Medical Center
March 11, 2025
Dr. Karl-Philipp Rommel discusses the renal denervation (RDN) procedure as a treatment for patients with severe, uncontrolled hypertension. RDN is primarily considered for patients whose blood pressure remains high despite multiple medications. He sees particular benefits for young patients, as their blood vessels are still flexible and more responsive to the treatment. He advocates for its broader use in clinical practice, particularly for patients struggling with medication adherence or side effects.
The case of a young patient, Sergiu, is discussed as an example. Despite severe hypertension and initial uncertainty about the success of RDN, the procedure led to a normalization of his blood pressure and a reduction in medication.
What was the particular challenge with the patient?
Dr. Karl-Philipp Rommel: The relatively young patient, aged 42, complained of the typical symptoms of inadequately controlled arterial hypertension: dizziness, headaches and chest pain. The patient had extremely high blood pressure. This was also evident in the long-term measurement. It was not entirely clear whether renal denervation would be a resounding success here, particularly because the blood pressure was extremely high. But renal denervation worked very well here, to the extent that in this case the medication could also be reduced. This is not the case for every patient and the aim of RDN cannot be to reduce the medication; rather, the aim is to reliably regulate the blood pressure.
What screenings do you normally carry out before the procedure?
Dr. Karl-Philipp Rommel: First of all, we rule out all causes that can lead to high blood pressure in all our patients, i.e. those causes that we can identify, including hormonal and metabolic disorders, sleep apnoea syndrome or narrowing of the renal arteries, all of which can ultimately lead to an increase in blood pressure. This increases the chance that patients will respond to renal denervation.
How safe is the treatment and is there a 100% success rate?
Dr. Karl-Philipp Rommel: Renal denervation is very safe. There are actually no major complications. About three quarters of patients respond to the procedure with a good reduction in blood pressure, about a quarter do not respond. If you are one of the patients who experience a reduction in blood pressure, you can also be sure that the reduction in blood pressure is relatively good.
How long does recovery take after such a procedure?
Dr. Karl-Philipp Rommel: Ultimately, it is a very minimally invasive procedure and patients can even go home the same day.
Can everyone with high blood pressure undergo this operation?
Dr. Karl-Philipp Rommel: It is certainly not suitable for every patient. The primary treatment for high blood pressure is drug therapy. Patients who do not respond adequately to drug treatment are particularly suitable for RDN.
What has your experience been with RDN therapy so far?
Dr. Karl-Philipp Rommel: We have ten years of experience with renal denervation. We have treated several hundred people, very different patients. We have had very good experiences, especially with those who are younger and who have severe high blood pressure. I believe that these are precisely the people who benefit from the added value of pure denervation and have had really well-controlled blood pressure for years.
Over the last ten years, we have been involved in really scientifically sound research into renal denervation and have been able to show that there is a really reliable blood pressure-lowering effect in various patient groups, with few medications as well as those with many medications. That is why we are convinced that we should use renal denervation in clinical routine when patients are inadequately controlled despite taking at least three blood pressure medications.
For which patients is renal denervation an option?
Dr. Karl-Philipp Rommel: I think this includes patients with inadequately controlled blood pressure, even though they are already taking three or more blood pressure medications. But there are also patients who may not tolerate the blood pressure medication and are therefore inadequately controlled. Or all those who may have a problem taking medication regularly and reliably. Here too, the effectiveness of renal denervation is based on the fact that blood pressure is controlled regardless of medication intake – the blood pressure-lowering effect works all day long and for many years. That is why I also think that young patients in particular are very good candidates for renal denervation.
Disclaimer: The interview features Dr. Rommel`s medical expertise sharing insights on renal denervation. Please note that the doctor was compensated for the time and effort involved in participating in this interview. The views and opinions expressed are those of the doctor and do not necessarily reflect those of Recor Medical or other experts.
