Despite taking five hypertension medications, a 75-year-old woman still experienced spikes in her blood pressure as high as 215/105 mm Hg requiring emergency care. Medical therapy failed to regulate these spikes. Her cardiologist was concerned about the potential for stroke and heart failure.
With no identifiable trigger, the patient’s attacks prohibited the patient from traveling even a few hours with her family. “I was afraid to go anywhere because I didn’t know when it was going to happen,” she says. “I was afraid to lie down.”
Her cardiologist referred her to a local facility for further evaluation, but the facility was not prepared to treat her. As her conditioned worsened and episodes became more frequent, the patient requested another referral from her cardiologist to Duke.
At Duke Heart, the team did an extensive workup to rule out any other possible causes, including the patient’s history of pituitary adenoma. Without a clear cause, the patient was left with few options.
How did the Duke Heart team treat this patient’s resistant hypertension?
Renal denervation offers a treatment option for patients with resistant hypertension. Duke has performed renal denervation for 10 years in research applications and, since FDA approval in 2023, in clinical use. Through the femoral arteries, the renal nerves are ablated with radiofrequency or ultrasound. The procedure has been shown to lower blood pressure in some patients.
Manesh R. Patel, MD, Duke’s chief of cardiology, performed the percutaneous procedure in October 2025. Since the outpatient procedure, the patient has had no recurrence of the episodes that sent her to the emergency room and has returned to many of her life activities, including visiting the beach with her family.
“Before the procedure, she was on five full-dose hypertensives plus two pro re nata medications to control blood pressure,” says Ann Lin, PA-C, MHS, who conducted the patient’s follow-up. “Since the procedure, she has come off one diuretic and reduced a blood pressure medication.”
“While we’re still trying to better understand the best target population for this procedure, it’s been used in practice for 10 years and seems to have a steady effect over that period,” says Patel. “Her presentation was very typical of responders, and her outcome has been fantastic.”
The earlier providers refer patients, the sooner they have access to the full resources of Duke Health. “If patients fail two or more antihypertensives or can’t tolerate these medications, there are still options,” Patel says. “Even if there are secondary hypertension conditions, including renal artery stenosis or severe untreated sleep apnea, referral is appropriate so we can offer patients the full treatment spectrum.”
