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See related article, pp 118–124
During the past several years, renal denervation by radio frequency ablation has emerged as an exciting new therapy for resistant hypertension.1 The initial concept was that this procedure would eliminate efferent sympathetic traffic to the kidney and, among other things, turn off the renin–angiotensin aldosterone system. However, studies in humans suggested that the primary blood pressure–lowering effects of this procedure were on the afferent side of the equation. The evolving idea is that sympathoexcitatory renal afferents are stimulated in resistant hypertension and that by eliminating or attenuating this afferent input, blood pressure will fall.1
In this edition of Hypertension, Hering et al,2 from the Baker Institute, provide further evidence in 35 carefully studied patients with resistant hypertension that renal denervation lowers blood pressure in these patients by ≈15%. Further, at least part of the blood pressure–lowering effects of the procedure are likely because of a reduction in sympathetic activity as assessed by serial measurement of muscle sympathetic nerve activity (MSNA). These observations are interpreted in the context of the sympathoexcitatory renal afferent narrative outlined above. Evidence discussed in this …