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Curr Hypertens Rep (2015) 17:11
DOI 10.1007/s11906-014-0519-8
BLOOD PRESSURE MONITORING AND MANAGEMENT (J COCKCROFT, SECTION EDITOR)
The Sympathetic Nervous System in Hypertension: Back to the Future?
Murray Esler
# Springer Science+Business Media New York 2015
Abstract The seventeenth century London neuroanatomical school headed by Thomas Willis published the first images of the sympathetic nervous system. Nineteenth century European physiologists characterised these as the pressor nerves. Von Eulers demonstration that the sympathetic transmitter was norepinephrine brought the field into the modern era. Sympathetic nervous system responses are regionally differentiated; human regional sympathetic activity is best studied by recording from postganglionic sympathetic efferents directed to the skeletal m uscle v asculature (clinical microneurography) and by measurement of organ-specific norepinephrine release to plasma from sympathetic nerves (regional norepinephrine spillover). With these techniques, the sympathetic nervous system became accessible to clinical scientists, allowing the demonstration that sympathetic nervous system activation is crucial in the development and outcomes of cardiovascular disorders, most notably heart failure and essential hypertension. Activation of the renal sympathetic out-flow is pivotal in the pathogenesis of essential hyper-tension. An important goal for clinical scientists is translation of knowledge of pathophysiology, such as this, into better treatment for patients. Although disputed, the case is strong that in hypertension, we are now on the cusp of effective mechanisms to management transition, with the use of catheter-based renal sympathetic nerve ablation for treating drug-resistant hypertension.
Keywords High blood pressure . Kidneys . Renal denervation . Arterial barostimulation . Norepinephrine . Sympathetic nervous system . Sympathetic nerve recording
Introduction
A Short History of the Pressor Nerves
Electrical stimulation of the sympathetic nerves, by nineteenth century European physiologists, demonstrated them to be vasoconstrictor and to elevate blood pressure, leading to the sobriquet, pressor nerves [1] and to the idea that the nervous system causes high blood pressure. In the early years of the twentieth century, no treatment of hypertension was available until the introduction of a surgical treatment based on this premise. Surgical sympathectomy [2, 3] severed sections of the sympathetic chain and all sympathetic nerves of the thorax and abdomen within reach, cutting as many pressor nerves as possible to remove their systemic vasoconstrictor effects. Selective renal sympathectomy was not performed at that time, as no theoretical case existed...