Carl Maronich (Host): This is Expert Insights, Life-Changing. I'm Carl Maronich, and with me today is Dr. Surya Chaturvedula, a Cardiologist with Carle Foundation Hospital. And we'll be talking about heart health, and specifically blood pressure and renal denervation. Doctor, welcome to the podcast.

Surya Chaturvedula, MD: Pleasure.

Host: Maybe we could start by explaining, what the current guidelines are for elevated blood pressure management and what folks should be aware of.

Surya Chaturvedula, MD: Sure. So, last year, that's in 2025, several societies came up with a new guideline for a change as a departure from the past. It's not called a hypertension guideline, but it's called an elevated blood pressure guideline because the focus is to act early and prevent any long-term damage. As you know, the normal blood pressure is 120 systolic and 80 diastolic, so anything over that is termed elevated blood pressure as long as your diastolic is still normal.

But once those barriers are breached, then they came up with a stage one and stage two hypertension.

Host: I see. And that's something that somebody initially going to their primary care provider, would learn and then may be referred to a cardiologist from there possibly?

Surya Chaturvedula, MD: I actually would, step back one, and even before going to a doctor. I think this is something that should become a part of one's life because you diagnose an elevated blood pressure with a simple maneuver like checking blood pressure at home. So if you are able to check the blood pressure at home and the numbers are alarming, then it's time, to see someone who specializes in it and also call for action making changes in your lifestyle, et cetera.

Host: Very good. I see. And let's talk a little bit about the significance of renal denervation, in the treatment of high blood pressure.

Surya Chaturvedula, MD: So this is the new kid on the block and we take care of patients who are termed as resistant hypertension. What it means in simple terms is when the patient and the provider are unable to get the blood pressure i n the range that they aspire to, the goal, despite using multiple medications, and typically more than three, we call it resistant hypertension. And it's seen that these are the patients who have long-term adverse outcomes in terms of increased strokes, heart attacks, congestive heart failure, kidney failure, et cetera.

So renal denervation is a procedure which is geared towards such patients.

Carl Maronich (Host): How exactly does renal denervation work?

Surya Chaturvedula, MD: So renal denervation is pretty self-explanatory. Denervation is you're going in with catheters and you're modulating the nerves which are surrounding the renal arteries, the arteries that supply the kidney. There is a crosstalk happening constantly between the kidney and the brain, and that leads to release of several hormones, which are important in keeping the blood pressure at goal, but sometimes when they're overactive, that's when the blood pressure goes up. And the fundamental idea behind the procedure is to modulate this crosstalk so that we can reduce the blood pressure.

Host: I see. So the initially for high blood pressure, the first-line of treatment would be a medication, I would guess. When might someone be a candidate for renal denervation?

Surya Chaturvedula, MD: The foundation for treatment is lifestyle and lifestyle modifications are extremely important, geared towards losing weight, maintaining an active lifestyle if you're an alcohol consumer, eliminating that, reducing sodium, increasing potassium, in your diet incorporating things like lots of greens and beets, which have been shown to be rich in natural vasodilators, meaning chemical substances, which reduce the blood pressure.

And then, then the second line of, attack is the blood pressure pills. And despite these, if the blood pressure is not under control, then comes the role for renal degeneration.

Host: I see. Then from that, are there risks associated with renal denervation?

Surya Chaturvedula, MD: Well, it is a procedure, so any procedure comes with risks, but these risks are pretty comparable to other procedures, like an angiogram, wherein you go into the arteries and do stents either in your heart or in the legs, et cetera. But, more than that, there is really not much harm associated with this procedure.

Host: Oh, very good. Earlier you mentioned resistant hypertension and how does that differ from regular, if you will hypertension?

Surya Chaturvedula, MD: Resistant hypertension is when the blood pressure cannot be kept in the goal range, despite the maximum effort, in terms of lifestyle modification and medications. And these patient's typically need 3, 4, 5, 6, sometimes seven pills to keep the blood pressure down. So when you're not able to control the blood pressure, that's when we term it resistant hypertension.

Host: I see. And back to renal denervation, would that be a standalone treatment, or would following that a patient still need medication?

Surya Chaturvedula, MD: It's an adjunct to the lifestyle modifications and the pills that we discussed, but, turns out that it is like taking another medication. So when compliance is of, uh, matter, especially as more number of pills for a patient to take, the burden goes up. It's very common that such patient's do not get their blood pressure down either because they can't take a pill because of side effects or they don't want to take a pill.

So this acts as an adjunct and hopefully over a period of time the need for escalation of the pills goes down. And in cases where there is excellent lifestyle modification, like someone losing five to 10% of their body weight, for example, they might be able to come down on the number of pills required.

Host: Yeah, Doctor, I really appreciate how you keep pushing me. Because I forget to mention the lifestyle modifications first. That might be a reflection of my personality, not wanting to do those things that we know we need to do. But, as you're saying, that plays huge role. Can you put a percentage on the number of patients who, show they have high blood pressure and they're able to control it solely with lifestyle changes?

Surya Chaturvedula, MD: So, it depends on what level of blood pressure elevation you are at. Someone who is at earliest phases of hypertension or elevated blood pressure; incorporating a lifestyle modification can be really helpful. Again, when we talk about lifestyle modification, there are several things which are part of it, which encompasses diet, exercise, losing weight, eliminating alcohol.

Each one of those things can reduce the blood pressure anywhere between two to eight millimeters. So when done well together, that can be a very useful tool to control the blood pressure.

Host: Yeah. Uh, stress is another, factor potentially in blood pressure and high blood pressure. Isn't that right?

Surya Chaturvedula, MD: That is exactly right. Stress, promotes body releasing adrenalin, and there's several other hormones, similar, to that which basically increase the tone of the blood vessel and can increase the heart rate and the blood pressure.

Host: Yeah. So whatever we can do to remove or lessen the stress in our life, that's going to be helpful in a lot of ways to our health. Isn't that right?

Surya Chaturvedula, MD: That's absolutely right. It's not only stress relief and also adequate sleep, and exercise. That's very, very important. And what we are learning more so is it's not just the routine mundane things that people associate with high blood pressure. Dementia is very closely related to uncontrolled blood pressure earlier in life.

Cognitive decline, which is a milder form of dementia as well. So sooner you are aware of your blood pressure being elevated and sooner you take action, better it is in later in life, and reducing the risk of dementia.

Host: Doctor, let's talk a little bit about how often someone should be getting their blood pressure checked and the best ways to do that.

Surya Chaturvedula, MD: It starts at home. I tell my patients that blood pressure is not something that is once a three months, once a six month doctor's office kind of an appointment type of thing. Blood pressure is something that you need to take ownership of and check your blood pressure at home, and I would prefer patients check blood pressure daily, but at least three to four times a week would be a good start.

Very common mistakes that people do, is to check it wrong. Because that can give you a wrong number. So the best practices for checking blood pressure are you want to make sure your bladder is empty. You're sitting on a seat very comfortably with your back rested well against, feet planted on the ground.

No crisscross, avoid talking, checking phones, watching TV, or engaging in a conversation with someone. And after, sitting down for a few minutes, you want to get your blood pressure machine. Now you want a good validated machine, and there is ways to know that your machine is validated. There's validate.bp.org that you can check your machine on.

You want to put the machine on a table, or a desk, with your arm at the level of your heart And the band going above your elbow with the lower border of the band going just across your elbow line, and you want to check a couple of blood pressures a few minutes apart. If you do such blood pressures once in the morning, once in the night, and, you bring that log to your provider, that's of an immense value rather than making a decision just on one blood pressure in the office.

Host: Yeah, so the home blood pressure kits that you can buy in a lot of different places, those have gotten to the point where they're quality enough that they will give you accurate readings?

Surya Chaturvedula, MD: As I said, you want to make sure that those are approved by making sure that they're validated.

Host: So that technology's advanced, I'm sure. And speaking of advanced technology with renal denervation, is the technology around that procedure advancing as well?

Surya Chaturvedula, MD: Absolutely. This history of renal denervation is quite fascinating and this is something that's been tested for decades. The early knowledge and experimentation was not very successful, and that took a lot of going back to the bench type of research and iterations in the catheter, iterations in the procedure, our own understanding of the process.All of those culminated into positive trial results very recently.

Host: Are there certain demographics that are affected by high blood pressure and resistant hypertension?

Surya Chaturvedula, MD: There is clearly a racial disparity in blood pressure and outcomes from uncontrolled blood pressure, which is much beyond just the patients preponderance with blood pressure, access to healthcare, compliance, health education, et cetera. All of that plays a big role. But non-Hispanic African-Americans are the, by far, the people, who are genetically predisposed both to uncontrolled blood pressure, as well as adverse outcomes. And one of the major factors there is the way their bodies handle sodium, which is a very, very important mineral in blood pressure regulation is very different from other's.

Host: Hmm, interesting. Doctor, how does Carle Foundation Hospital approach the treatment of heart health issues, specifically blood pressure?

Surya Chaturvedula, MD: Both, Foundation Hospital in Champaign as well as Methodist Medical Center in Peoria; we have hypertension focus groups and we have hypertension clinics and we are bringing the renal denervation to aid the maneuvers that I said, the lifestyle modification, health, education, medication management.

And this will be another, thing in our armory to serve our patients who are battling uncontrolled blood pressure.

Host: Doctor, one thing I didn't ask earlier. Renal denervation, that procedure, if someone goes through that procedure, what should they expect the recovery time to be and, how will that work?

Surya Chaturvedula, MD: This is like an outpatient procedure, like an angiogram procedure for your heart, or if you're getting a stent to your legs, et cetera. As things stand today, this procedure is performed through the artery in the groin, so. Typically this is a outpatient procedure, a few hours in the hospital getting the procedure, usually with sedation because this can be a little bit of a patient discomfort during the procedure.

So sedation analgesia pain relief are the standards of care. Then you can expect to spend the next few hours being observed in the hospital and able to go home next day. Because the artery in the groin is punctured, which is typically closed at the end of the procedure, there would be some precautions, for about a week or so to allow for healing of that site.

Host: Yeah. And that's a procedure that you, the cardiologist would do?

Surya Chaturvedula, MD: That is correct.

Host: And then there would be follow-up with you and, and perhaps with a primary care provider?

Surya Chaturvedula, MD: That is exactly right.

Host: And speaking of the primary care provider, they often say healthcare is a kind of a team sport. So someone who's going through high blood pressure, really, they need to make sure they're collaborating with all their different providers. Isn't that accurate?

Surya Chaturvedula, MD: That's absolutely correct. It's just not the providers, the nurses that they talk to, who give them education. The medical assistants who typically are the first contact in the offices who check their blood pressures. This is a lifelong journey and the education about how to check the blood pressure, when to act, and how not to ignore high blood pressure, et cetera. It's an ongoing effort by the entire infrastructure.

Host: And back to the lifestyle changes, it's also a bit of a family affair, I would guess. You want to make sure everyone in the family's on board, so everyone's eating healthily, getting good exercise, and all those things.

Surya Chaturvedula, MD: Absolutely starts with the parents. Encouraging kids to have a healthy diet and a lifestyle so that you can even, prevent this from becoming a problem. So, it absolutely, it's a family and a lifestyle and a cultural kind of thing.

Host: Dr. Surya Chaturvedula, you've been a great font of information, around blood pressure today. We so much appreciate it.

Surya Chaturvedula, MD: You're welcome.

Host: For more information, go to carle.org. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Carl Maronich, and This is Expert Insights, Life-Changing. Thanks for listening.