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Secondary Causes: Work-Up and Its Specificities in CKD: Influence of Autonomic Dysfunction

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Resistant Hypertension in Chronic Kidney Disease

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Abstract

Failure to achieve blood pressure goal, despite adherence to judiciously administered antihypertensive medication, defines resistant hypertension and raises a critical and costly health problem. Excessive activation of the sympathetic nervous system plays a major role in the development and maintenance of primary hypertension, and the frequent comorbidities associated with resistant hypertension appear to enhance this pathogenic mechanism. Chronic kidney disease (CKD) is a frequent comorbid condition linked to resistant hypertension in a bidirectional manner, and evidence of sympathetic activation in CKD is increasing. This chapter briefly reviews the mechanisms of blood pressure regulation by the kidneys and their control by the sympathetic nervous system to provide the conceptual framework for the review of clinical and experimental evidence for the sympathetic activation in resistant hypertension and the mechanisms responsible for this autonomic dysfunction. The use of novel non-pharmacological approaches for sympathoinhibition in resistant hypertension is discussed in light of the recent clinical trials. Finally, particular aspects regarding the mechanistic role of sympathetic activation in CKD and resistant hypertension are discussed.

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Authors and Affiliations

  1. Department of Pharmacology, University of Medicine and Pharmacy “Gr. T. Popa” Iaşi, Iaşi, Romania

    Radu Iliescu

  2. Department of Physiology, University of Medicine and Pharmacy “Gr. T. Popa” Iaşi, Iaşi, Romania

    Dragomir Nicolae Şerban

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  1. Radu Iliescu
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  2. Dragomir Nicolae Şerban
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Correspondence to Radu Iliescu .

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Editors and Affiliations

  1. Grigore T. Popa University of Medicine, Iaşi, Romania

    Adrian Covic

  2. Department of Medicine, Division of Nephrology, University School of Medicine, Istanbul, Turkey

    Mehmet Kanbay

  3. Section of Nephrology, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, Illinois, USA

    Edgar V. Lerma

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Iliescu, R., Şerban, D.N. (2017). Secondary Causes: Work-Up and Its Specificities in CKD: Influence of Autonomic Dysfunction. In: Covic, A., Kanbay, M., Lerma, E. (eds) Resistant Hypertension in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-56827-0_10

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