Device-based investigational* therapeutic approaches targeting the sympathetic nervous system

The sympathetic nervous system (SNS) plays a key role in hypertension. Most patients with treatment-resistant hypertension and no apparent secondary causes display chronic SNS overactivity. Therefore, multiple device-based therapies targeting the SNS are currently under investigation.

Renal denervation

The renal afferent and efferent sympathetic nerves play a key role in the feedback loop of sympathetic overactivity that promotes hypertension, making them an appropriate target for treatment.1 Renal denervation, an investigational* therapy, is a minimally invasive, catheter-based procedure that modulates the output of nerves lying within the renal artery wall, leading into and out of the kidneys.1-4 

Baroreceptor stimulation

Baroreceptor stimulation is an investigational therapeutic approach that treats hypertension by modulating sympathetic nerve activity. A permanent, surgically implanted device similar to a pacemaker administers the therapy by electrical stimulation of the carotid baroreceptors. Baroreceptor stimulation attempts to reduce sympathovagal imbalance by lowering the activity of the SNS5 while increasing parasympathetic activity.6

*Device-based approaches such as renal denervation and baroreceptor stimulation are not universally approved for use, and are under clinical investigation in some regions (such as the US and Japan).

References

  1. Schlaich MP, Sobotka PA, Krum H, Whitbourn R, Walton A, Esler MD. Hypertension. 2009;54:1195-1201.
  2. Papademetriou V, Doumas M, Tsioufis K. Int J Hypertens. 2011;2011:196518.
  3. Schlaich M, Krum H, Walton T, et al. A novel catheter based approach to denervate the human kidney reduces blood pressure and muscle sympathetic nerve activity in a patient with end stage renal disease and hypertension.  2011. Presented at the European Society of Hypertension Meeting June 2009.
  4. Krum H, Schlaich M, Whitbourn R, et al. Lancet. 2009;373:1275-1281.
  5. Heusser K, Tank J, Engeli S, et al. Hypertension. 2010;55:619-626.
  6. Wustmann K, Kucera JP, Scheffers I, et al. Hypertension. 2009;54:530-536.

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