Hypertension and new treatment approaches targeting the sympathetic nervous system.

The prevalence of primary and resistant hypertension in the United States is increasing. Even with an ever-expanding array of pharmacotherapy available, a large percentage of patients do not meet guideline blood pressure (BP) goals. Not achieving BP goals clearly increases cardiovascular morbidity and mortality, and results in the progression of kidney disease. The inability to adequately control BP is multifactorial, however a major contributing factor, besides inadequate diuretic therapy, is the failure of pharmacotherapy to inhibit the sympathetic nervous system (SNS) effectively. Tolerability of anti-hypertensives targeting the SNS is moderate at best. Consequently, device-driven approaches are being developed and tested. Recent investigation includes renal denervation and baroreflex activation therapy, which show promising, but at times conflicting, results.