title: Catheter-based renal denervation in the treatment of resistant hypertension.
abstract: Clinical trials have shown that catheter-based renal denervation (RD), i.e. interruption of afferent and efferent sympathetic nerves supplying the kidney, can reduce systolic blood pressure (BP) by approximately 30 mm Hg. This technology is currently being tested as a therapeutic option for patients with resistant hypertension, a condition in which BP remains elevated despite adherence to a rational medication regimen. This novel treatment approach was developed on the basis of a wealth of animal and human research demonstrating the importance of the sympathorenal axis in the pathogenesis of hypertension. Sympathetic efferent signals to the kidneys raise BP by stimulating sodium retention and renin release, and the kidneys influence central sympathetic drive via afferent nerves. But as is true with many therapeutic advances, RD has shown benefit in clinical studies long before the mechanisms are fully understood. Additional research is needed to understand the contribution of afferent sympathetic nerve interruption to BP reductions observed with RD; to examine the degree and significance of re-innervation following RD; to elucidate factors that may lead to a lack of response to RD in some patients; to determine whether the modulation of the sympathetic nervous system via RD can have beneficial effects independent of BP reduction; and to develop methods to measure the effectiveness of RD in real time.
authors: Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA. rstouff@med.unc.edu
authors: G A
authors: GA
authors: Stouffer
authors: G F
authors: GF
authors: Dibona
authors: A
authors: A
authors: Patel
authors: P
authors: P
authors: Kaul
authors: A L
authors: AL
authors: Hinderliter
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D017115:Catheter Ablation / Q000379:methods*; D003714:Denervation / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007668:Kidney / Q000294:innervation*
keywords: Hypertension; Renal denervation; Sympathetic nervous system