Point: Chronic activation of the sympathetic nervous system is the dominant contributor to systemic hypertension.

@article{Esler2010PointCA,
  title={Point: Chronic activation of the sympathetic nervous system is the dominant contributor to systemic hypertension.},
  author={Murray Esler and Elisabeth A. Lambert and Markus P. Schlaich},
  journal={Journal of applied physiology},
  year={2010},
  volume={109 6},
  pages={
          1996-8; discussion 2016
        }
}
For the past three decades, the renin-angiotensin system has been the major focus in high blood pressure research. The proven value of antihypertensive drugs that block this system has deflected research from other blood pressure-raising systems, including the sympathetic nervous system. Despite 
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Last Word on Point: Chronic activation of the sympathetic nervous system is the dominant contributor to systemic hypertension

to the editor: I thank my friends, colleagues, and opponents for their thoughtful submissions (see Ref. [1][1]), which capture the diversity of views concerning the pathophysiological mechanisms of…

Counterpoint: Activation of the intrarenal renin-angiotensin system is the dominant contributor to systemic hypertension.

TLDR
The dominant mechanism responsible for hypertension calls to mind the famous poem, “The Blind Men and the Elephant,” by John Godfrey Saxe based on an ancient fable from India, which described the elephant based on their specific encounter.

The sympathetic nervous system and blood pressure in humans: implications for hypertension

TLDR
A perspective on the actions and interactions of angiotensin II, inflammation and vascular dysfunction/brain hypoperfusion in the pathogenesis and progression of neurogenic hypertension is provided.

Physiology: hemodynamics, endothelial function, renin-angiotensin-aldosterone system, sympathetic nervous system.

  • L. G. Navar
  • Biology, Medicine
    Journal of the American Society of Hypertension : JASH
  • 2014

Pathophysiology of Renal Sympathetic Denervation (RSDN)

Activation of the sympathetic nervous system (SNS) has been identified as a key pathophysiological feature involved in the initiation, progression but also prognosis of most cardiometabolic disorders…

Renal denervation for resistant hypertension.

  • M. AlmeidaP. GonçalvesE. OliveiraH. Carvalho
  • Medicine, Biology
    Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
  • 2015

The Causal Role of Chronic Mental Stress in the Pathogenesis of Essential Hypertension

TLDR
The idea that essential hypertension may arise through psychosomatic mechanisms is an old one and one finds an unusual frequency of those who as directors of big enterprises had a great deal of responsibility and demanding jobs, and who, after a long period of mental overwork, became nervous.

The crosstalk between the kidney and the central nervous system: the role of renal nerves in blood pressure regulation

TLDR
The role of renal nerves is described as the key carrier of signals from the kidneys to the CNS and vice versa; the brain and kidneys communicate through this carrier to maintain homeostasis in the body.

Comments on Point:Counterpoint: The dominant contributor to systemic hypertension: Chronic activation of the sympathetic nervous system vs. Activation of the intrarenal renin-angiotensin system

TLDR
It is reported that urinary angiotensinogen levels are significantly greater in hypertensive patients not treated with RAS blockers compared with normotensive subjects, and an activated intrarenal RAS is correlated with high blood pressure in humans.

Central regulation of sympathetic nerve activity by adipokines and insulin

TLDR
Hormones that circulate in the blood and cross the blood brain barrier are thought to activate specific regions, which play important roles in energy homeostasis and cardiovascular regulation.
...

References

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TLDR
The renal sympathetic nerves have been identified as a major contributor to the complex pathophysiology of hypertension in both experimental models and in humans and may be modulated by afferent signaling from renal sensory nerves.

Sympathetic activation in chronic renal failure.

TLDR
Analysis of potential mechanisms underlying sympathetic activation in chronic kidney disease, the range of adverse consequences associated with this activation, and potential therapeutic implications resulting from this relationship are analyzed.

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TLDR
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TLDR
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Sympathetic Augmentation in Hypertension: Role of Nerve Firing, Norepinephrine Reuptake, and Angiotensin Neuromodulation

TLDR
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TLDR
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TLDR
The effect of bilateral dorsal rhizotomy on the development of hypertension and neuroadrenergic activity in the anterior, lateral, and posterior hypothalamic nuclei, in the locus ceruleus, and in the nucleus tractus solitarius of Sprague-Dawley rats that underwent 5/6 nephrectomy or were sham operated is evaluated.

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Sympathetic Neural Activation in Nondiabetic Metabolic Syndrome and Its Further Augmentation by Hypertension

TLDR
It is suggested that MS is a state of sympathetic nerve hyperactivity and that the additional presence of hypertension further intensifies this hyperactivity.