Thierry H Le Jemtel1,2, William Richardson3, Rohan Samson4, Abhishek Jaiswal4, Suzanne Oparil5. 1. Division of Cardiology, Tulane University Medical Center, New Orleans, Louisiana, USA. lejemtel@tulane.edu. 2. Division of Cardiology, Tulane University School of Medicine, 1430 Tulane Ave SL-42, New Orleans, LA, 70112, USA. lejemtel@tulane.edu. 3. Department of Surgery, Ochsner Health System, New Orleans, Louisiana, USA. 4. Division of Cardiology, Tulane University Medical Center, New Orleans, Louisiana, USA. 5. Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA.
Abstract
PURPOSE OF REVIEW: The review assesses the role of non-pharmacologic therapy for obesity and chronic kidney disease (CKD) associated refractory hypertension (rf HTN). RECENT FINDINGS: Hypertensive patients with markedly heightened sympathetic nervous system (SNS) activity are prone to develop refractory hypertension (rfHTN). Patients with obesity and chronic kidney disease (CKD)-associated HTN have particularly heightened SNS activity and are at high risk of rfHTN. The role of bariatric surgery is increasingly recognized in treatment of obesity. Current evidence advocates for a greater role of bariatric surgery in the management of obesity-associated HTN. In contrast, renal denervation does not appear have a role in the management of obesity or CKD-associated HTN. The role of baroreflex activation as adjunctive anti-hypertensive therapy remains to be defined.
PURPOSE OF REVIEW: The review assesses the role of non-pharmacologic therapy for obesity and chronic kidney disease (CKD) associated refractory hypertension (rf HTN). RECENT FINDINGS:Hypertensivepatients with markedly heightened sympathetic nervous system (SNS) activity are prone to develop refractory hypertension (rfHTN). Patients with obesity and chronic kidney disease (CKD)-associated HTN have particularly heightened SNS activity and are at high risk of rfHTN. The role of bariatric surgery is increasingly recognized in treatment of obesity. Current evidence advocates for a greater role of bariatric surgery in the management of obesity-associated HTN. In contrast, renal denervation does not appear have a role in the management of obesity or CKD-associated HTN. The role of baroreflex activation as adjunctive anti-hypertensive therapy remains to be defined.
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