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Introduction <p>Interventions targeting sympathetic activity, such as renal denervation, have produced only modest blood pressure (BP) reductions. Historically, thoracolumbar sympathectomy (1935–1960) improved BP control and long-term outcomes. Thoracoscopic sympathectomy now applies this principle in a minimally invasive manner, for example in hyperhidrosis and facial blushing.</p> Aim <p>To evaluate the efficacy and safety of thoracoscopic sympathectomy in patients with resistant hypertension. </p> Methods <p>In this small, blinded study of patients with resistant hypertension (24-h systolic BP ≥ 150 mmHg on ≥ 3 antihypertensive agents) five patients were randomized to thoracoscopic sympathectomy (n = 3) or sham (n = 2).</p> Results <p>All procedures were well tolerated, with no persistent adverse events. At three-year follow-up, the sympathectomy group showed 24-h systolic BP reductions of 26, 62, and 56 mmHg; sham patients had reductions of 49 and 2 mmHg. Biochemical markers of sympathetic activity and heart rate variability showed no significant group differences.</p> Conclusions <p>Thoracoscopic sympathectomy appears safe, but the study does not allow meaningful conclusions about its effect on BP due to the small sample size and treatment adjustments.</p> Graphical Abstract <p></p>

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Thoracoscopic Sympathectomy in Treatment-Resistant Essential Hypertension: A Novel Approach to Reduce Sympathetic Activity and Blood Pressure

  • 期刊论文

  • 发表日期：

    2026年3月28日

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  • Mark Reinhard,
  • Amal Derai,
  • Niels Henrik Buus,
  • Per Løgstrup Poulsen,
  • Morten Bendixen,
  • Peter Juhl-Olsen,
  • Kent Lodberg Christensen

摘要

Introduction

Interventions targeting sympathetic activity, such as renal denervation, have produced only modest blood pressure (BP) reductions. Historically, thoracolumbar sympathectomy (1935–1960) improved BP control and long-term outcomes. Thoracoscopic sympathectomy now applies this principle in a minimally invasive manner, for example in hyperhidrosis and facial blushing.

Aim

To evaluate the efficacy and safety of thoracoscopic sympathectomy in patients with resistant hypertension.

Methods

In this small, blinded study of patients with resistant hypertension (24-h systolic BP ≥ 150 mmHg on ≥ 3 antihypertensive agents) five patients were randomized to thoracoscopic sympathectomy (n = 3) or sham (n = 2).

Results

All procedures were well tolerated, with no persistent adverse events. At three-year follow-up, the sympathectomy group showed 24-h systolic BP reductions of 26, 62, and 56 mmHg; sham patients had reductions of 49 and 2 mmHg. Biochemical markers of sympathetic activity and heart rate variability showed no significant group differences.

Conclusions

Thoracoscopic sympathectomy appears safe, but the study does not allow meaningful conclusions about its effect on BP due to the small sample size and treatment adjustments.

Graphical Abstract