Nearly half of all American adults are living with high blood pressure. Most know the drill: watch the salt, exercise more, take the medication. But what happens when you do all of that, every single thing your doctor tells you, and that number still won’t move?
For millions of people, that is exactly their reality, and most of them have been told there is nothing more that can be done.
On a recent episode of The Heart of Innovation on KDOW, my co-host Dr. John Phillips and I went deep on a procedure that most patients, and honestly many physicians, don’t even know exists yet. It’s called renal denervation. It’s FDA-approved. And as of October 2025, it’s covered by Medicare.
We were joined by two people who have spent over a decade inside this technology: Julie Trudel, Medtronic’s Senior Director of R&D, and Jason Fontana, VP of Global Marketing and Renal Denervation General Manager. To understand why this procedure matters, you first have to understand something about your kidneys that most people are never told.
The Nerve Pathway Pills Can’t Reach
Most people know kidneys filter waste and manage fluid. What most people don’t know is that a web of sympathetic nerves runs from your brain, down your spine, and wraps directly around your renal artery, and those nerves have a powerful hand in controlling your blood pressure.
“Those sympathetic nerves,” Julie explained, “like a little mesh of spaghetti that runs around the renal artery, they control the tone of your artery and dictate how much resistance to flow that artery will present to the body.”
Standard blood pressure medications target the kidneys’ hormonal systems, things like renin and fluid retention. But none of them directly target this nerve network. Which means for some patients, no matter how many pills they take, there’s a signaling problem running in the background that medication was never designed to reach.
In a healthy system, those nerves respond to stress and then stand down. In many patients with resistant hypertension, they never stand down. Jason described it plainly: “In a lot of patients with high blood pressure, that sense that everything is amped up, these nerves are constantly firing.” The body stays locked in a permanent fight-or-flight state, and the pills aren’t built to address it.
Doctors understood this nerve connection as far back as the 1930s. Their solution was to open patients up near the spine and physically cut the nerves. “Quite often when you do it surgically, these are hard to see,” Julie said, “and you may cut more than what you really should be cutting.” It worked, but at a real cost, and it faded from practice once blood pressure medications arrived.
Then catheter technology changed the equation. By the mid-2000s, the question was no longer whether those nerves could be calmed. It was whether you could do it without a single incision.
A catheter goes into the renal artery. Energy is applied against the vessel wall. Julie asked us to try something during the show: rub your hands together quickly. Feel the warmth? That’s the principle.
“What we’re doing with that little catheter, we’re bringing energy right against the vessel wall,” she said. “That energy makes the tissue around the renal artery vibrate like you did with your hand. By generating all this vibration, the nerves end up warming up just enough to a point where their activity level gets interrupted.”
No cutting, no implant, nothing left behind in the body.
“What we’ve been able to figure out,” Jason added, “is that you make this one spot, this one change, interrupt the signaling in the kidney, and that calms down all these nerves throughout the body.”
Getting to that moment of clarity, though, required surviving a crisis that nearly killed the technology entirely.
January 13, 2014
Jason remembered the date without pausing.
“Very cold day in Minneapolis. We were in a room with our CEO, Omar Ishak.”
The Symplicity HTN-3 trial had just produced results that seemed to say the procedure didn’t work. The kind of results that end programs. The kind that send teams home.
Ishak asked three questions. Is it safe? “It’s completely safe. No safety signal at all.” Do you think it works? “Yes, we do. And this is why.” Then came the last one, which Jason described as “not funny at the time, but funny now.” The CEO looked at them and said: “This is why we do research.”
The program survived, though barely.
“It was close to being dead,” Julie said. “I can only be so grateful for the general manager, Jason, Nina, Sean Salman, and Jason Wyman, who went in front of our CEO and advocated for it. It took champions.”
They went back into the data. Over 600 separate analyses of that one trial. “We knew every angle,” Jason said, “and everything that kind of went wrong.” Two problems kept surfacing. The original device required manual, point-by-point ablation: move the catheter, fire, move again. No two physicians performed it quite the same way, and no two patients got quite the same treatment. And critically, the team had no reliable way to confirm whether patients were actually taking their medications during the trial. Without that, they couldn’t cleanly separate the procedure’s effect from the noise.
Julie redesigned the catheter from the ground up. The new version, called the Spiral, applied ablations in a corkscrew pattern, ensuring consistent contact with the vessel wall regardless of who was performing the procedure. They restructured the trials to include medication monitoring. Then they started over.
What kept them going was a letter.
A man in his seventies from Florida had wanted to enroll in HTN-3 but couldn’t find a participating hospital near his hometown. So he paid out of pocket and flew to Germany to have the procedure done. His blood pressure dropped. He came off medications that had been causing him terrible side effects. And when HTN-3 failed and it looked like the technology might disappear, he sat down at a typewriter and wrote to Medtronic.
“Dear Medtronic, I want to tell you, keep continuing this procedure.”
The letter worked its way through the company until it reached Julie’s desk. Jason still remembered the patient’s words: “I got my life back.”
That letter, from a man who flew to another country and typed his case on a typewriter because he wanted others to have what he had, carried a team through 600 analyses and a near-death moment in a Minneapolis conference room, all the way to FDA approval in November 2023.
As Dr. Phillips said at the top of the show, quoting Babe Ruth: “It’s hard to beat a person who never gives up.”
Now the question is whether patients know this option exists…because the healthcare system, as Dr. Phillips described it, is not doing a great job of making sure they find out.
If You’ve Been Told Your Blood Pressure Is Uncontrollable
He called it a chronic “pass the buck” problem with hypertension. A cardiologist spots elevated pressure, adds it to the notes, tells the patient to stay on their meds and talk to their primary care doctor. The primary care doctor assumes the cardiologist would have acted if it were serious. A nephrologist maybe gets looped in eventually. The patient moves through the system and nobody owns the problem.
“Very few patients are controlled appropriately,” Dr. Phillips said. “And it’s often a pass-the-buck kind of treatment.”
Renal denervation is designed for the patient stuck in that loop, someone already doing everything right who still can’t get their numbers down. Jason described the ideal candidate clearly: “You’ve done lifestyle management, you’ve done the right thing. You’re taking your medications, you may be on one, two, three, four medications, and your blood pressure is still high. You’re doing the right thing, but you need a little help.”
Not everyone with high blood pressure qualifies; the indication is specific to uncontrolled hypertension in patients who have already exhausted the conventional options. And it doesn’t replace medication. Dr. Phillips put it simply: “Think of it as an airbag in your car. But always put your seatbelt on too.”
As for the procedure itself, it runs about 15 to 20 minutes under sedation, a catheter goes in through the groin artery with the wrist approach in development, and patients go home the same day. “Your blood pressure might change a little,” Dr. Phillips said, “so just be cognizant of that. We’re always following these patients closely.”
You Deserve to Know This Exists
The Symplicity Spyral received FDA approval in November 2023. Medicare finalized national coverage in October 2025. The clinical data now stretches to three years and continues to strengthen, with blood pressure reductions remaining durable well beyond the procedure date. The only thing missing is patients who know to ask for it.
If you’re on multiple blood pressure medications and your numbers are still high, bring your home readings to your next appointment and ask your doctor directly about renal denervation and the Symplicity Spyral system. Don’t wait for it to come up. In a system that tends to pass the buck, the patient who advocates for themselves is the patient who gets answers. This procedure exists. It’s covered. And now you know to ask for it.
The Heart of Innovation airs on KDOW AM 1220, brought to you by the Global PAD Association at padhelp.org. Hosted by Emmy Award-winning journalist and Global PAD Association founder Kym McNicholas and interventional cardiologist Dr. John Phillips, founder of Save My Piggies Health and Wellness.
