When 7 Medications Fail: Novel Procedure Opens New Path for Severe Hypertension

"I stared at the numbers for a long time, thinking I must have misread them."

This was the text message a medical team at Seoul National University Hospital recently received from a patient in their 50s. Checking their blood pressure at home, the patient could hardly believe what the monitor displayed: 114/83 mmHg.

Despite taking six different antihypertensive medications, their blood pressure had consistently hovered around a dangerous 160/120 mmHg. For the first time, it had returned to a normal range. "Thank you for giving me a new life," the patient added.

In South Korea, one in three adults lives with high blood pressure. While most manage it through lifestyle changes, exercise, or one to two medications, a subset of patients remains unresponsive even to maximum dosages of multiple drugs—a clinical condition known as resistant hypertension.

Resistant hypertension is far more than just elevated numbers on a screen; it carries a drastically higher risk of heart attacks, strokes, heart failure, and chronic kidney disease. It is not uncommon for patients with blood pressure spiking above 180–200 mmHg to require frequent emergency room visits or hospitalizations.

For those left behind by conventional drug therapies, Renal Denervation (RDN) is opening a vital new frontier.

Beyond filtering waste, the kidneys play a central role in regulating systemic blood pressure. Surrounding the renal arteries is a dense network of sympathetic nerves. When overactive, these nerves constrict blood vessels and trigger sodium and water retention, driving blood pressure steadily higher.

RDN works by selectively ablating these hyperactive sympathetic nerve signals. Rather than temporarily managing symptoms with daily medication, it targets the underlying physiological cause.

Building on traditional catheter-based (intravascular) methods, a next-generation technique is now taking hold: laparoscopic and robotic extravascular renal denervation (eRDN). By directly ablating the nerves from outside the renal artery wall, this minimally invasive approach delivers a more complete and potent blood pressure-lowering effect.

Case 1 (50-year-old female): Struggling with blood pressure above 200/120 mmHg despite seven medications, she suffered frequent emergency room admissions. Following laparoscopic eRDN, her blood pressure stabilized so rapidly that she completely discontinued all medications by month six. At her one-year follow-up, she maintains normal blood pressure on just two low-dose medications.

Case 2 (19-year-old male): Facing a strong family history of stroke and heart disease, he was taking six high-dose medications at a young age without relief. One year after receiving eRDN in a clinical trial, his blood pressure is fully controlled on only two medications, dramatically easing his long-held fear of severe cardiovascular events.

Historically, physicians had few options for such patients beyond adding yet another pill or raising dosages. In contrast, eRDN requires minimal incisions, causes negligible surgical trauma, and offers an exceptionally favorable safety and recovery profile.

"Blood pressure is not just a number; it is a vital metric that protects the heart, brain, and kidneys," said Professor Chang Wook Jeong of the Department of Urology at Seoul National University Hospital. "For patients whose hypertension remains uncontrolled despite taking multiple drugs, a new therapeutic solution was urgently needed."

In 2019, Prof. Jeong founded MedTech innovator DeepQure Inc. to advance laparoscopic and robotic eRDN into clinical development worldwide.

While domestic clinical trials in South Korea are nearing completion, U.S. clinical trials—approved by the FDA—are actively underway across five premier academic medical centers, including Stanford University Hospital, Mayo Clinic, UC Irvine, University of Florida, and Henry Ford Hospital.

In the Korean trial, 12-month follow-up data from nine patients demonstrated an extraordinary mean systolic blood pressure reduction of 51 mmHg (falling from a baseline average of 165 mmHg to 114 mmHg post-procedure)—a reduction substantially greater than those historically reported in catheter-based RDN studies.

"Surgical candidates are carefully selected among resistant hypertension patients through rigorous evaluation after multi-drug pharmacotherapy proves insufficient," Prof. Jeong noted. "Instead of simply adding more pills, targeting the root cause of high blood pressure is finally becoming a reality."

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