Is renal denervation an alternative or a complement to aldosterone antagonists in treatment of resistant hypertension?

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The role of the sympathetic nervous system in the pathophysiology of hypertension, particularly in resistant hypertension, is substantiated by a huge body of experimental and clinical arguments. Despite that, very little evidence is available in favor of a major effect of peripheral blockade of sympathetic receptors in essential hypertension [1–3]. Thus, several new therapeutic strategies have focused on targeting the hyperactivation of the sympathetic nervous system through renal denervation (RDN) or other devices interfering with the baroreflex [4]. Despite encouraging early results, a recent meta-analysis [5] has concluded for an unsatisfactory effect of RDN, and there is still a lot of discussion as to the real long-term extent of the blood pressure (BP)-lowering effect of RDN, especially when compared to the BP-lowering effect of intensified drug treatment, particularly with aldosterone receptor antagonists.

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