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.
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 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).
- Schlaich MP, Sobotka PA, Krum H, Whitbourn R, Walton A, Esler MD. Hypertension. 2009;54:1195-1201.
- Papademetriou V, Doumas M, Tsioufis K. Int J Hypertens. 2011;2011:196518.
- 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.
- Krum H, Schlaich M, Whitbourn R, et al. Lancet. 2009;373:1275-1281.
- Heusser K, Tank J, Engeli S, et al. Hypertension. 2010;55:619-626.
- Wustmann K, Kucera JP, Scheffers I, et al. Hypertension. 2009;54:530-536.
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