Renal sympathetic denervation for resistant hypertension--an alternate view

Catheter-based renal denervation (RDN) is an effective treatment for resistant hypertension. But negative results with this procedure are also not uncommon. It is believed that the effectiveness of RDN is due to decreased sympathetic activity. It is suggested that the beneficial action of RDN could also at least, in part, due to restoration of balance between sympathetic and parasympathetic nervous systems. Thus, occasional negative results seen with RDN to decrease blood pressure may be attributed to failure of restoration of this balance to near normal or normal. This hypothesis explains the involvement of free radicals, immune system and nitric oxide pathways in the pathogenesis of essential hypertension since both sympathetic and parasympathetic branches of autonomic nervous system have modulatory influence on these systems. Hence, it is suggested that efforts made to augment parasympathetic tone in addition to RDN may form a more effective strategy to reduce blood pressure in resistant hypertension than RDN alone.