Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Fondazione Policlinico Universitario Tor Vergata, Viale Oxford 81, 00133, Roma, Italy.
Radiol Med. 2012 Apr;117(3):426-44. doi: 10.1007/s11547-011-0766-6. Epub 2012 Jan 7.
This study was done to investigate the efficacy and safety of percutaneous renal denervation with the Symplicity catheter for reducing blood pressure in patients with essential hypertension resistant to medical therapy (systolic blood pressure >160 mmHg despite the use of three or more antihypertensive drugs, including a diuretic).
In September 2010, five patients affected by essential hypertension resistant to medical therapy were treated. All patients were studied by computed tomography angiography (CTA) of the renal arteries before the procedure and underwent follow-up at 30 and 60 days with colour Doppler ultrasound (CDUS) with evaluation of resistive index, glomerular filtration rate (GFR), 24-h blood pressure and serum catecholamine concentration. Student's t test was used to assess the effectiveness of the procedure in lowering blood pressure.
In treated patients, mean blood pressure at baseline was 171/100 mmHg [standard deviation (SD) ± 8/10]; mean GFR was 91.6 ml/min/1.73 m(2) (SD ± 15). Blood pressure after the procedure was reduced by -18/-5 and -13/-10 mmHg at 30 and 60 days, respectively, with a mean medication reduction of 3.6. No complications occurred during the intra- or periprocedural period or during short-term follow-up.
The Symplicity system proved to be efficacious and without serious adverse events in reducing blood pressure and antihypertensive medication use in patients affected by essential hypertension resistant to medical therapy. Although encouraging, our data are preliminary and need to be validated by larger prospective randomised studies.
本研究旨在探讨经皮肾动脉去神经术（Symplicity 导管）治疗药物抵抗性高血压（收缩压 >160mmHg，尽管使用了包括利尿剂在内的三种或更多种降压药物）的疗效和安全性。
2010 年 9 月，对 5 例药物抵抗性高血压患者进行了治疗。所有患者均在术前进行了肾动脉计算机断层血管造影（CTA）检查，并在 30 天和 60 天进行彩色多普勒超声（CDUS）随访，评估阻力指数、肾小球滤过率（GFR）、24 小时血压和血清儿茶酚胺浓度。采用 Student's t 检验评估该程序降低血压的效果。
治疗组患者的基线血压为 171/100mmHg[标准差（SD）±8/10]；平均 GFR 为 91.6ml/min/1.73m2（SD±15）。术后 30 天和 60 天血压分别降低-18/-5mmHg 和-13/-10mmHg，平均降压药物减少 3.6 种。在围手术期或短期随访期间，未发生任何并发症。
Symplicity 系统在降低血压和减少药物治疗方面，对药物抵抗性高血压患者是有效且无严重不良事件的。尽管令人鼓舞，但我们的数据是初步的，需要更大规模的前瞻性随机研究来验证。
