The Sympathetic Nervous System in Hypertension

Increased sympathetic nerve activity plays a major role in the pathogenesis of hypertension. There is an increased sympathetic nerve activity in hypertension not just because of the pathogenesis of primary hypertension, but because of parasympathetic dysfunction. Peripheral sensory neuropathy also can be observed in hypertension without diabetes mellitus. In resistant hypertension, a neurovascular pulsatile compression of the brain stem on the left side may cause sustained sympathetic overactivity, leading to increased blood pressure. A neurovascular decompression may be prescribed because subsequently the arterial systolic and diastolic blood pressure and sympathetic nerve activity may decrease permanently after the procedure. The baseline blood pressure is independent of the type of the neurovascular pulsatile compression of the brain stem on the left side, but in a case of double compression on the left side after a decompression there is a bigger reduction of blood pressure. The transcatheter renal radiofrequency denervation may lead to a significant decrease of blood pressure and sympathetic nerve activity also.