Hypertension refractory to conventional management with medication remains a
significant cause of cardiovascular morbidity and mortality. Alternative
strategies are warranted in this subgroup of patients. The target of these
strategies centers around sympathetic neural activity, which is thought to play
a key role in hypertension. We will review the historic and current approaches
toward altering sympathetic neural activity, specifically discussing surgical
sympathectomy, catheter-based renal denervation strategies, and baroreflex
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