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Results support a primarily adolescent-driven process of stress transmission in families. These results suggest that interventions to reduce adolescent stress, as well as to reduce parents' reactivity to adolescents, may be warranted. BACKGROUND Renal denervation is effective for modulating augmented sympathetic nerve activity (SNA) in heart failure with reduced ejection fraction (HFrEF). We have demonstrated that renal iodine123-metaiodobenzylguanidine (123I-MIBG) scintigraphy is associated with muscle sympathetic nerve a