title: Blood Pressure: Return of the Sympathetics?
abstract: This brief review highlights new ideas about the role of the sympathetic nervous system in human blood pressure regulation. We emphasize how this role varies with age and sex and use our findings to raise questions about the sympathetic nervous system and hypertension in humans. We also focus on three additional areas, including (1) novel ideas about the carotid body and sympathoexcitation as it relates to hypertension, (2) clinical trials of renal denervation that attempted to treat hypertension by reducing ongoing sympathoexcitation, and (3) new ideas about resistant hypertension and cerebral blood flow. We further highlight that success of device-based therapy to modulate the sympathetic nervous system relies heavily on patient selection. Furthermore, data suggest that the majority of patients respond to anti-hypertensive therapy and the major cause of "resistant" hypertension is poor patient adherence. While the enthusiasm for device therapy or perhaps even "precision medicine" is high, it is likely that by far the most benefit to the most patients will occur via better screening, more aggressive therapy, and the development of strategies that improve patient adherence to medication regimens and lifestyle changes.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA. joyner.michael@mayo.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Joyner
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
authors.forename: Jacqueline K
authors.initials: JK
authors.lastname: Limberg
mesh_terms: D000367:Age Factors; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D003714:Denervation; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D012727:Sex Characteristics
chemical_list: D000959:Antihypertensive Agents
keywords: Aging; Cerebral blood flow; Chemoreceptors; Hypertension; Renal denervation; Sex; Sympathetic nervous system