Essential hypertension,
insulin resistance,
heart failure, congestion,
diuretic resistance, and functional renal disease are all characterized by excessive central sympathetic drive. The contribution of the kidney's somatic afferent nerves, as an underlying cause of elevated central sympathetic drive, and the consequences of excessive efferent sympathetic signals to the kidney itself, as well as other organs, identify the renal sympathetic nerves as a uniquely logical therapeutic target for diseases linked by excessive central sympathetic drive. Clinical studies of renal
denervation in patients with resistant
hypertension using an endovascular
radiofrequency ablation methodology have exposed the sympathetic link between these conditions. Renal
denervation could be expected to simultaneously affect blood pressure,
insulin resistance,
sleep disorders, congestion in
heart failure,
cardiorenal syndrome and
diuretic resistance. The striking epidemiologic evidence for coexistence of these disorders suggests common causal pathways. Chronic activation of the sympathetic nervous system has been associated with components of the
metabolic syndrome, such as blood pressure elevation,
obesity,
dyslipidemia, and impaired fasting
glucose with
hyperinsulinemia. Over 50% of patients with
essential hypertension are hyperinsulinemic, regardless of whether they are untreated or in a stable program of treatment.
Insulin resistance is related to sympathetic drive via a bidirectional mechanism. In this manuscript, we review the data that suggests that selective impairment of renal somatic afferent and sympathetic efferent nerves in patients with resistant
hypertension both reduces markers of central sympathetic drive and favorably impacts diseases linked through central sympathetics-
insulin resistance,
heart failure, congestion,
diuretic resistance, and cardiorenal disorders.