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Renal nerve stimulation to predict responders to renal denervation

Journal of Human Hypertension volume 29, pages 281–282 (2015)Cite this article

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There is strong experimental evidence to suggest that increased renal sympathetic nerve activity have a pivotal role in the development and maintenance of hypertension. Increased activation of renal sympathetic efferent nerves has been demonstrated in experimental animals and in human hypertension.1, 2 Stimulation of renal sympathetic nerves increases blood pressure in hypertensive animals and interruption of postganglionic sympathetic nerve activity reduces blood pressure.3 Moreover, early studies in humans with surgical sympathectomy, before modern antihypertensive drug therapy was available, showed marked blood pressure reductions and improved prognosis, albeit with profound side effects.4

The first studies of catheter-based endovascular renal sympathetic denervation in patients with treatment-resistant hypertension showed marked and sustained reductions in office blood pressure.5 However, these initial studies were generally uncontrolled or limited to a non-interventional control arm, and included patients based on their office blood pressure values. Indeed, compared with office blood pressure measurements, the effects of renal denervation on ambulatory blood pressure were considerably smaller.6 More recently, a randomised single-blinded controlled study including an interventional sham procedure failed to show a significant reduction in office blood pressure or ambulatory blood pressure by renal denervation beyond that observed in the control group,7 and others have demonstrated that renal denervation provides no additional benefit to patients with true resistant hypertension when persistence to drug therapy has been ascertained.8

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

    T Kahan & J Spaak

  2. Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden

    T Kahan & J Spaak

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  1. T Kahan
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Correspondence to T Kahan.

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Competing interests

TK: Research grants from Celladon, Medtronic, Pfizer, and Servier; all outside the submitted work. JS: Research grant from AbbVie; all outside the submitted work.

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Kahan, T., Spaak, J. Renal nerve stimulation to predict responders to renal denervation. J Hum Hypertens 29, 281–282 (2015). https://doi.org/10.1038/jhh.2014.109

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