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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
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In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
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Vasodilators, primarily affecting the smooth muscles within arterial and venous walls, are commonly used for hypertension treatment. Medications such as minoxidil and hydralazine primarily target arteries and arterioles, while sodium nitroprusside acts on arterioles and venules. Minoxidil, functioning as a prodrug, is metabolized by hepatic sulfotransferase into its active form, minoxidil sulfate, after oral administration. This metabolite binds to the sulfonylurea receptor (SUR) component of...
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Updated: Oct 12, 2025

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
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Renal denervation for resistant hypertension.

Anna Pisano1, Luigi Francesco Iannone2, Antonio Leo2

  • 1Institute of Clinical Physiology, CNR - Italian National Council of Research, Reggio Calabria, Italy.

The Cochrane Database of Systematic Reviews
|November 22, 2021
PubMed
Summary

Renal denervation shows low-certainty evidence for improving major cardiovascular outcomes in resistant hypertension. However, moderate evidence suggests it may lower 24-hour ambulatory and office diastolic blood pressure.

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Area of Science:

  • Cardiology
  • Nephrology
  • Interventional Cardiology

Background:

  • Resistant hypertension is common and difficult to manage, with limited success in improving patient outcomes or reducing cardiovascular and renal risk.
  • Renal sympathetic hyperactivity is a key driver of resistant hypertension, leading to the investigation of renal denervation as a therapeutic option.

Purpose of the Study:

  • To evaluate the short- and long-term effects of renal denervation in resistant hypertension patients.
  • To assess impacts on clinical endpoints, cardiovascular events, mortality, hospital admissions, quality of life, blood pressure, cardiac structure, and kidney function.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing renal denervation to standard therapy or sham procedures.
  • Searched multiple databases up to November 2020, with no language restrictions.
  • Assessed risk of bias and summarized treatment effects using random-effects meta-analyses, with certainty of evidence assessed by GRADE.

Main Results:

  • Low-certainty evidence indicates renal denervation has little to no effect on myocardial infarction, ischemic stroke, unstable angina, or hospitalizations.
  • Moderate-certainty evidence suggests renal denervation may reduce 24-hour ambulatory systolic and diastolic blood pressure, and office diastolic blood pressure.
  • The procedure showed little to no effect on office systolic blood pressure, serum creatinine, or estimated glomerular filtration rate (eGFR).

Conclusions:

  • Renal denervation demonstrates low-certainty evidence for improving major cardiovascular outcomes and renal function in resistant hypertension.
  • Moderate-certainty evidence supports its potential to improve 24-hour ambulatory and office diastolic blood pressure.
  • Further trials with patient-centered outcomes, longer follow-up, larger samples, and standardized methods are needed to clarify its utility.