Renal nerve ablation as a tool for studying the interactions between arterial stiffness, blood pressure and sympathetic drive: Weight of the evidence

摘要

In the past few years renal nerve ablation has gained growing clinical popularity and research interest, becoming one of the most 'crowded' areas of investigation, as documented by the large number of original articles, reviews, editorials, and official documents by scientific societies focused on this issue since 2008, when the Simplicity HTN-1 data were published in The Lancet. This is justified by the importance afferent and efferent renal sympathetic nerves may have in favoring the development and progression of a high blood pressure state. Also, sympathetic neural influences are deeply involved in the homeostatic control of cardiovascular and metabolic function and may participate, independently of the increase in blood pressure load, at the development and progression of cardiac and vascular end-organ damage. This is additionally supported by the evidence that arterial stiffness, that is, a parameter closely correlated with the cardiovascular risk in hypertension as well as in other disease, is under tonic adrenergic neural influences. The present issue of the Journal of Hypertension includes an intriguing article reporting the results of a study focused on renal nerve ablation and aimed at addressing three major questions. First, whether renal denervation has favorable effects on arterial stiffness, known to be markedly altered in patients with resistant hypertension. Second, whether these effects are related to the changes in sympathetic neural outflow, which appears to be remarkably activated in this clinical condition. And third, whether the modifications in arterial stiffness might participate in the blood pressure-lowering effects of the procedure.