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Renal denervation: basic and clinical evidence

Hypertension Research volume 45, pages 198–209 (2022)Cite this article

Abstract

Renal nerves have critical roles in regulating blood pressure and fluid volume, and their dysfunction is closely related with cardiovascular diseases. Renal nerves are composed of sympathetic efferent and sensory afferent nerves. Activation of the efferent renal sympathetic nerves induces renin secretion, sodium absorption, and increased renal vascular resistance, which lead to increased blood pressure and fluid retention. Afferent renal sensory nerves, which are densely innervated in the renal pelvic wall, project to the hypothalamic paraventricular nucleus in the brain to modulate sympathetic outflow to the periphery, including the heart, kidneys, and arterioles. The effects of renal denervation on the cardiovascular system are mediated by both efferent denervation and afferent denervation. The first half of this review focuses on basic research using animal models of hypertension and heart failure, and addresses the therapeutic effects of renal denervation for hypertension and heart failure, including underlying mechanisms. The second half of this review focuses on clinical research related to catheter-based renal denervation in patients with hypertension. Randomized sham-controlled trials using second-generation devices, endovascular radiofrequency-based devices and ultrasound-based devices are reviewed and their results are assessed. This review summarizes the basic and clinical evidence of renal denervation to date, and discusses future prospects and potential developments in renal denervation therapy for cardiovascular diseases.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan

    Kenichi Katsurada & Kazuomi Kario

  2. Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan

    Kenichi Katsurada

  3. Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan

    Keisuke Shinohara

  4. Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan

    Keisuke Shinohara

  5. Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan

    Jiro Aoki

  6. Department of Cardiovascular Medicine, Nishinomiya Municipal Central Hospital, Hyogo, Japan

    Shinsuke Nanto

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Correspondence to Kazuomi Kario.

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K. Kario received speaker fees and works as a consultant to JIMRO Co., Ltd., Medtronic Co. Inc. and Terumo Co. Inc. SN received a consultant fee from JIMRO Co., Ltd. KS was supported by grants from Daiichi Sankyo and Nippon Boehringer Ingelheim. The authors declare no competing interests.

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Katsurada, K., Shinohara, K., Aoki, J. et al. Renal denervation: basic and clinical evidence. Hypertens Res 45, 198–209 (2022). https://doi.org/10.1038/s41440-021-00827-7

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