Universität zu Köln

Sobotka, Paul A., Mahfoud, Felix, Schlaich, Markus P., Hoppe, Uta C., Bohm, Michael and Krum, Henry (2011). Sympatho-renal axis in chronic disease. Clin. Res. Cardiol., 100 (12). S. 1049 - 1058. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-0692

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Abstract

Essential hypertension, insulin resistance, heart failure, congestion, diuretic resistance, and functional renal disease are all characterized by excessive central sympathetic drive. The contribution of the kidney's somatic afferent nerves, as an underlying cause of elevated central sympathetic drive, and the consequences of excessive efferent sympathetic signals to the kidney itself, as well as other organs, identify the renal sympathetic nerves as a uniquely logical therapeutic target for diseases linked by excessive central sympathetic drive. Clinical studies of renal denervation in patients with resistant hypertension using an endovascular radiofrequency ablation methodology have exposed the sympathetic link between these conditions. Renal denervation could be expected to simultaneously affect blood pressure, insulin resistance, sleep disorders, congestion in heart failure, cardiorenal syndrome and diuretic resistance. The striking epidemiologic evidence for coexistence of these disorders suggests common causal pathways. Chronic activation of the sympathetic nervous system has been associated with components of the metabolic syndrome, such as blood pressure elevation, obesity, dyslipidemia, and impaired fasting glucose with hyperinsulinemia. Over 50% of patients with essential hypertension are hyperinsulinemic, regardless of whether they are untreated or in a stable program of treatment. Insulin resistance is related to sympathetic drive via a bidirectional mechanism. In this manuscript, we review the data that suggests that selective impairment of renal somatic afferent and sympathetic efferent nerves in patients with resistant hypertension both reduces markers of central sympathetic drive and favorably impacts diseases linked through central sympathetics-insulin resistance, heart failure, congestion, diuretic resistance, and cardiorenal disorders.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Sobotka, Paul A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mahfoud, Felix UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlaich, Markus P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoppe, Uta C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bohm, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Krum, Henry UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-484755
DOI:	10.1007/s00392-011-0335-y
Journal or Publication Title:	Clin. Res. Cardiol.
Volume:	100
Number:	12
Page Range:	S. 1049 - 1058
Date:	2011
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1861-0692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CHRONIC HEART-FAILURE; PLACEBO-CONTROLLED TRIAL; RESISTANT HYPERTENSION; NERVOUS-SYSTEM; BLOOD-PRESSURE; PLASMA NOREPINEPHRINE; CARDIORENAL SYNDROME; INSULIN-RESISTANCE; SODIUM RETENTION; RISK-FACTORS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/48475