A Walton, Jennifer Goss, Kari Alitalo, Z Tsun, Yuantao Wang, Katharina Machura, Agnes Machnik, Wolfgang Neuhofer, Kai-Uwe Eckardt, R Whitbourn, Armin Kurtz, Jonathan Jantsch, N van Rooijen, Dominik N. Müller, WT Abraham, Eberhard Ritz, Murray D. Esler, Karl F. Hilgers, Agata Ziomber, Wolfgang Derer, Friedrich C. Luft, F. X. Beck, Joon-Keun Park, Tuomas Tammela, B Kapelak, Peter Dietsch, H Sievert, J Sadowski, Hubertus Wagner, Dontscho Kerjaschki, Anke Dahlmann, Jens Titze, Paul A. Sobotka, S. Thambar, Henry Krum, Markus P. Schlaich, and Krzysztof Bartus
Catheter-based renal sympathetic denervation for resistant hypertension: A multicenter safety and proof-of-principle cohort study. Lancet 373: 1275–1281, 2009 {#article-title-2} 1886 1888 Upon the initiative of Smithwick and Thompson (1) of the Massachusetts General Hospital, resection of the splanchnic nerves through a posterior infradiaphragmatic approach plus removal of the sympathetic chain from the level of the eighth dorsal ganglion to the second lumbar ganglion had been used with relative frequency in cases of desperate hypertension at the time when antihypertensive medication was not yet available. In the hands of other investigators, the results were spectacular in a minority of patients but not quite satisfactory in many patients (2,3). Despite improvement of headache, reversal of papilledema in malignant hypertension, etc. , the long-term reduction of BP was quite variable and the 5-yr mortality remained approximately 40% (2). A 10-yr follow-up compared 100 patients who were subjected to thoracolumbar sympathectomy with 1500 patients who received symptomatic therapy. Lasting BP reduction was seen only in one third of the patients (4). Whereas the average BP levels were reduced, occasional BP spikes were not. The average difference of preoperative to postoperative systolic BP values was 21 mmHg. The authors saw reduction of cerebrovascular accidents and less progression of proteinuria and renal dysfunction, but 10-yr mortality was still 41%. Against this background, once effective antihypertensive medication was available, this relatively crude procedure fell out of favor and remained a sleeping beauty. With today's better insight into the role of sympathetic activity in the genesis of hypertension and particularly the role of the kidney in sympathetic activation, there has been a renaissance in the interest of the renal sympathetic nervous system, including its role in primary hypertension—apart from its undoubted role in the hypertension of chronic kidney disease (5–10). Renal disease and, in animal experiments, even minor renal tissue damage such as injection of minute volumes of phenol, trigger afferent signals that ascend via …