Increased central sympathetic drive is a hallmark of several important clinical conditions including
essential hypertension,
heart failure,
chronic kidney disease, and
insulin resistance. Afferent signaling from the kidneys has been identified as an important contributor to elevated central sympathetic drive and increased sympathetic outflow to the kidney and other organs is crucially involved in cardiovascular control. While the resultant effects on renal hemodynamic parameters,
sodium and water retention, and
renin release are particularly relevant for both acute and long term regulation of blood pressure, increased sympathetic outflow to other vascular beds may facilitate further adverse consequences of sustained sympathetic activation such as
insulin resistance, which is commonly associated with
hypertension. Recent clinical studies using
catheter-based
radiofrequency ablation technology to achieve functional renal
denervation in patients with resistant
hypertension have identified the renal nerves as therapeutic target and have helped to further expose the sympathetic link between
hypertension and
insulin resistance. Initial data from two clinical trials and several smaller mechanistic clinical studies indicate that this novel approach may indeed provide a safe and effective treatment alternative for resistant
hypertension and some of its adverse consequences.