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The autonomic nervous system and renal physiology

Authors D'Elia JA, Weinrauch LA

Published Date August 2013 Volume 2013:6 Pages 149—160

DOI http://dx.doi.org/10.2147/IJNRD.S40897

Received 6 June 2013, Accepted 28 June 2013, Published 30 August 2013

John A D'Elia,1,2 Larry A Weinrauch1,2

1Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Department of Medicine, Harvard Medical School, Boston, MA, USA

Abstract: Research in resistant hypertension has again focused on autonomic nervous system denervation – 50 years after it had been stopped due to postural hypotension and availability of newer drugs. These (ganglionic blockers) drugs have all been similarly stopped, due to postural hypotension and yet newer antihypertensive agents. Recent demonstration of the feasibility of limited regional transcatheter sympathetic denervation has excited clinicians due to potential therapeutic implications. Standard use of ambulatory blood pressure recording equipment may alter our understanding of the diagnosis, potential treatment strategies, and health care outcomes – when faced with patients whose office blood pressure remains in the hypertensive range – while under treatment with three antihypertensive drugs at the highest tolerable doses, plus a diuretic. We review herein clinical relationships between autonomic function, resistant hypertension, current treatment strategies, and reflect upon the possibility of changes in our approach to resistant hypertension.

Keywords: resistant hypertension, renal sympathetic ablation, autonomic nervous system, ambulatory blood pressure monitoring, blood pressure control

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