title: Pathophysiology and Potential Non-Pharmacologic Treatments of Obesity or Kidney Disease Associated Refractory Hypertension.
abstract: OBJECTIVE
  The review assesses the role of non-pharmacologic therapy for obesity and chronic kidney disease (CKD) associated refractory hypertension (rf HTN).
  
  
  RESULTS
  Hypertensive patients with markedly heightened sympathetic nervous system (SNS) activity are prone to develop refractory hypertension (rfHTN). Patients with obesity and chronic kidney disease (CKD)-associated HTN have particularly heightened SNS activity and are at high risk of rfHTN. The role of bariatric surgery is increasingly recognized in treatment of obesity. Current evidence advocates for a greater role of bariatric surgery in the management of obesity-associated HTN. In contrast, renal denervation does not appear have a role in the management of obesity or CKD-associated HTN. The role of baroreflex activation as adjunctive anti-hypertensive therapy remains to be defined.
authors.affiliation: Division of Cardiology, Tulane University Medical Center, New Orleans, Louisiana, USA. lejemtel@tulane.edu.|Division of Cardiology, Tulane University School of Medicine, 1430 Tulane Ave SL-42, New Orleans, LA, 70112, USA. lejemtel@tulane.edu.
authors.forename: Thierry H
authors.initials: TH
authors.lastname: Le Jemtel
authors.affiliation: Department of Surgery, Ochsner Health System, New Orleans, Louisiana, USA.
authors.forename: William
authors.initials: W
authors.lastname: Richardson
authors.affiliation: Division of Cardiology, Tulane University Medical Center, New Orleans, Louisiana, USA.
authors.forename: Rohan
authors.initials: R
authors.lastname: Samson
authors.affiliation: Division of Cardiology, Tulane University Medical Center, New Orleans, Louisiana, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Jaiswal
authors.affiliation: Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D050110:Bariatric Surgery / Q000379:methods*; D003714:Denervation / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology; D009765:Obesity / Q000150:complications / Q000628:therapy*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*; D013564:Sympathetic Nervous System / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents
keywords: Bariatric surgery; Chronic kidney disease; Hypertension; Obesity; Renal denervation