Emerging topics on renal denervation in hypertension: anatomical and functional aspects of renal nerves

Inappropriate sympathetic activation is closely associated with the development and progression of hypertension. Renal denervation (RDN) is a neuromodulation therapy performed using an intraarterial catheter in patients with hypertension. Recent randomized sham-operated controlled trials have shown that RDN has significant antihypertensive effects that last for at least 3 years. Based on this evidence, RDN is nearly ready for general clinical application. On the other hand, there are remaining issues to be addressed, including elucidation of the precise antihypertensive mechanisms of RDN, the appropriate endpoint of RDN during the procedure, and the association between reinnervation after RDN and the long-term effects of RDN. This mini review focuses on studies implicating anatomy of the renal nerves, which consist of afferent or efferent and sympathetic or parasympathetic nerves, the response of blood pressure to renal nerve stimulation, and reinnervation of renal nerves after RDN. A comprehensive understanding of the anatomical and functional aspects of the renal nerves and the antihypertensive mechanisms of RDN, including its long-term effects, will enhance our ability to incorporate RDN into strategies to treat hypertension in clinical practice.

Automated summary

Inappropriate sympathetic activation is closely linked to hypertension. Renal denervation is an effective therapy for hypertension with significant and lasting antihypertensive effects. However, there are still issues to be addressed, such as the precise mechanisms and long-term effects of renal denervation. Comprehensive understanding of renal nerves and the antihypertensive mechanisms of renal denervation will improve its clinical application.