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Reviews
Johns, EJ,Abdulla, MH
2013
September
Renal nerves in blood pressure regulation
Validated
1
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afferent renal nerves hypertension kidney renal sympathetic nerves sympathetic nervous system SPONTANEOUSLY HYPERTENSIVE-RATS NERVOUS-SYSTEM OVERACTIVITY POTENTIAL VANILLOID TYPE-1 SUBSTANCE-P RECEPTORS LONG-TERM CONTROL RESISTANT HYPERTENSION ARTERIAL-PRESSURE RENIN RELEASE SYMPATHETIC OVERACTIVITY BARORECEPTOR REFLEX
PurposeThis review highlights the physiological mechanisms underlying the neural regulation of the kidney, normally to maintain cardiovascular homeostasis, and in pathophysiological states of hypertension and renal disease. It is relevant because of the demonstration that bilateral renal denervation in different hypertensive groups causes a sustained reduction in blood pressure.Recent findingsThere are patients groups in whom their hypertension is resistant to antihypertensive drugs or with renal diseases in which they are contraindicated. Recently, medical devices have been developed to manipulate the sympathetic nervous system, for example, implantation of carotid sinus nerve stimulating electrodes and ablation of the renal innervation. These approaches have been relatively successful but there remains a lack of understanding of the neural mechanisms impinging on the kidney that regulate long-term control of blood pressure.SummaryThe observation that bilateral renal nerve ablation can reduce blood pressure represents an important therapeutic milestone. Nonetheless, questions arise as to the underlying mechanisms, the long-term consequences, whether there may be re-innervation over a number of years, or whether some unknown consequence to the denervation may arise. This may point to the development of novel compounds targeted to the innervation of the kidney.
504
510
10.1097/MNH.0b013e3283641a89
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