Device-based approaches to target renal sympathetic nerves for hypertension

Markus Schlaich, Murray D. Esler

Research output: Chapter in Book/Conference paperChapter

Abstract

Sympathetic nervous system (SNS) activation is a common feature of arterial hypertension and has been demonstrated to contribute to the development and progression of the hypertensive state. The use of surgical procedures and, to a lesser extent, devices, has a long history in the management of hypertension. Indeed, surgery has been the preferred treatment modality in some forms of secondary hypertension for decades. Furthermore, surgical section of the sympathetic chain and splanchnic nerves was commonly used before effective pharmacologic treatment of hypertension was available. Faced with the failure in the conventional pharmacological treatment of hypertension, devices and surgical procedures are being increasingly evaluated. The wider ‘device revolution’ in cardiovascular medicine has now come to hypertension with the testing of a device to lower blood pressure by guiding respiration, direct electrical stimulation of brain regions influencing blood pressure, the re-evaluation of a device to stimulate the arterial baroreceptors, surgical neurovascular depression of the brainstem, to overcome presumed vascular compression of bulbar regions controlling sympathetic outflow and blood pressure, and development and testing of catheterbased approaches using radiofrequency energy for ablation of renal nerves. This chapter briefly reviews the anatomy and physiology of the renal nerves and their involvement in hypertension and other relevant disease states, the available clinical data on safety and efficacy of renal nerve ablation, discusses other potential implications, and introduces some of the new devices currently under investigation for RDN.
Original languageEnglish
Title of host publicationSurgery of the Autonomic Nervous System
EditorsJonathan A. Hyam, Erlick A. C. Pereira, Alexander L. Green
PublisherOxford University Press
Chapter5
ISBN (Print)9780199686407
DOIs
Publication statusPublished - 2016

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Schlaich, M., & Esler, M. D. (2016). Device-based approaches to target renal sympathetic nerves for hypertension. In J. A. Hyam, E. A. C. Pereira, & A. L. Green (Eds.), Surgery of the Autonomic Nervous System Oxford University Press. https://doi.org/10.1093/med/9780199686407.003.0005