Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University/Alfred Hospital, Melbourne, Victoria 3004, Australia.
Hypertension. 2011 May;57(5):911-7. doi: 10.1161/HYPERTENSIONAHA.110.163014. Epub 2011 Mar 14.
Renal sympathetic hyperactivity is seminal in the maintenance and progression of hypertension. Catheter-based renal sympathetic denervation has been shown to significantly reduce blood pressure (BP) in patients with hypertension. Durability of effect beyond 1 year using this novel technique has never been reported. A cohort of 45 patients with resistant hypertension (systolic BP ≥160 mm Hg on ≥3 antihypertension drugs, including a diuretic) has been originally published. Herein, we report longer-term follow-up data on these and a larger group of similar patients subsequently treated with catheter-based renal denervation in a nonrandomized manner. We treated 153 patients with catheter-based renal sympathetic denervation at 19 centers in Australia, Europe, and the United States. Mean age was 57±11 years, 39% were women, 31% were diabetic, and 22% had coronary artery disease. Baseline values included mean office BP of 176/98±17/15 mm Hg, mean of 5 antihypertension medications, and an estimated glomerular filtration rate of 83±20 mL/min per 1.73 m(2). The median time from first to last radiofrequency energy ablation was 38 minutes. The procedure was without complication in 97% of patients (149 of 153). The 4 acute procedural complications included 3 groin pseudoaneurysms and 1 renal artery dissection, all managed without further sequelae. Postprocedure office BPs were reduced by 20/10, 24/11, 25/11, 23/11, 26/14, and 32/14 mm Hg at 1, 3, 6, 12, 18, and 24 months, respectively. In conclusion, in patients with resistant hypertension, catheter-based renal sympathetic denervation results in a substantial reduction in BP sustained out to ≥2 years of follow-up, without significant adverse events.
肾交感神经活性在高血压的维持和进展中起着重要作用。经导管肾交感神经去神经支配已被证明可显著降低高血压患者的血压（BP）。使用这种新方法，其效果持续超过 1 年的持久性从未有过报道。最初发表了一项 45 例难治性高血压患者（服用≥3 种降压药后收缩压≥160mmHg，包括利尿剂）的队列研究。在此，我们报告了这些患者和随后以非随机方式接受经导管肾去神经支配治疗的更大一组类似患者的更长时间随访数据。我们在澳大利亚、欧洲和美国的 19 个中心对 153 例患者进行了经导管肾交感神经去神经支配治疗。平均年龄为 57±11 岁，39%为女性，31%为糖尿病患者，22%有冠心病。基线值包括诊室血压平均值为 176/98±17/15mmHg，使用 5 种降压药物，估计肾小球滤过率为 83±20mL/min/1.73m2。从第一次到最后一次射频能量消融的中位数时间为 38 分钟。97%（153 例中的 149 例）的患者手术过程无并发症。4 例急性手术并发症包括 3 例腹股沟假性动脉瘤和 1 例肾动脉夹层，均无需进一步处理。术后诊室血压分别在 1、3、6、12、18 和 24 个月时降低 20/10、24/11、25/11、23/11、26/14 和 32/14mmHg。总之，在难治性高血压患者中，经导管肾交感神经去神经支配可显著降低血压，且持续 2 年以上，无明显不良事件。
