ROLE OF THE NURSE IN CATHETER RENAL DENERVATION – A MODERN METHOD FOR THE TREATMENT OF SEVERE ARTERIAL HYPERTENSION

Abstract

Arterial hypertension is one of the most common chronic, socially significant diseases worldwide, affecting a large proportion of the population. Arterial hypertension is a major cardiovascular risk factor for many diseases including stroke, making it one of the most common causes of death. Despite the simple way to diagnose it, only 1/3 of patients are adequately treated. (Wolf Maier, Cooper, Kramer, et al, 2004) In a certain percentage of them, despite regular intake of several medications, blood pressure (BP) values remain high this constitutes so
called resistant arterial hypertension. According to the clinical guidelines of the European Society of Hypertension, resistant hypertension is defined as a BP measurement > 140/90 mm Hg, against a background of treatment with more than 3 antihypertensive drugs in full dose, one of which is a diuretic, and a healthy lifestyle is maintained. (Buso, Agabiti Rosei, et al, 2024) The frequency of prevalence of resistant hypertension ranges from 9 to 27%, according to different registries and has been increasing over the last decades. Resistant hypertension has been shown to significantly increase the risk of cardiovascular events, renal failure and death.
The basis of the pathophysiology of resistant hypertension is the assumption of increased latent intravascular volume, and this is one reason for drug resistance in the treatment of arterial hypertension. There is a correlation between pathologic changes of the kidney and the progress of arterial hypertension as vice versa, long term hypertension can also cause chronic kidney disease and renal failure. Here, renal denervation is applicable, and Bulgaria was one of the first countries to introduce this method (2008).
Catheter renal denervation is one of the modern methods for the treatment of resistant hypertension. It is an invasive procedure in which radiofrequency energy is delivered through a special catheter positioned in the renal arteries, thereby interrupting the nerve endings by reducing the tension between the sympathetic nervous system, the central nervous system and the renal mechanisms responsible for high blood pressure. The biggest positive is that "Renal denervation cuts the spikes in blood pressure and this is extremely important." (Петров, 2024) Given that this is an invasive treatment method, it is important to point out the specific role of the nurse who, through her knowledge, experience and technique, manages to assist the operator adequately and with dignity. The aim is to present the nurse's involvement in its entirety, and to understand its importance for the final outcome of the procedure. Providing a quality healthcare service is directly related to good collaboration between members of the medical team, and this brings satisfaction and higher benefits to all parties.