The sympathetic nervous system plays a permissive, if not primary causal role in the genesis and maintenance of human essential hypertension. Excessive sympathetic nervous system activity in man is most apparent in early forms of hypertension (prehypertension and white-coat type). Renal nerves are of particular interest because of their roles in modulating the activity of the renin-angiotensin system and renal sodium excretion. Renal denervation substantially ameliorates the development of hypertension in animal models such as renovascular, spontaneously hypertensive, and steroid-induced hypertension in rats and aortic coarctation in dogs. In man, catheter ablation of renal nerves has been undertaken in the late phases of hypertension; in a rigorously controlled trial in resistant hypertension (SYMPLICITY HTN-3), renal denervation did not reduce blood pressure over the long term. Is this because renal denervation is more appropriate to prevent than treat late-stage hypertension? Are there anatomical or technical barriers yet to be overcome in the procedure? These and other issues are addressed by two experts in this issue of the controversies series: Deepak L. Bhatt and Murray Epstein.
Keywords: Sympathetic nervous system (SNS); blood pressure; human; hypertension; renal denervation; sympathectomy.
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