Tip 21 (October 2013)
Publically funded renal sympathetic denervation (RSDN) programme now up and running at North Shore
Hospital.
See my “Tip” from December 2012 cautioning against referral of patients with resistant hypertension before
thorough evaluation for treatable secondary causes and before all possible pharmacological options have been
tried.
Notwithstanding those cautions, there is a small subgroup of individuals with severe and genuinely refractory
hypertension in whom RSDN is appropriate. I am happy to report that the procedure is now available as a
publically funded service at North Shore Hospital for Waitemata DHB residents. Waitemata is the only DHB
which is providing this service at the present time, and we have been treating patients there since June 2013. The
service is a collaboration between the hypertension clinic (me), two interventional cardiologists (Seif El-Jack
and Ali Khan) and an interventional radiologist (John Bottomley)
All patients are processed through the Waitemata Hypertension Clinic to ensure that only appropriate
candidates are selected. The procedure is done as a day case and all 7 patients we have treated so far are doing
well.
As a rough guide for general practitioners, we suggest referring patients who have an office systolic blood
pressure which averages 160mmHg or more, on what appears to be maximal tolerated therapy (usually 3 or
more blood pressure medications). Paper or electronic referrals should be made to the Waitemata DHB
Hypertension Clinic. North Shore Hospital, in the same way as normal hypertension referrals