Ram C V S, Kumar A S
1] Apollo Institute for Blood Pressure Management, Apollo Blood Pressure Clinics, Apollo Hospitals, Hyderabad, India [2] Texas Blood Pressure Institute, University of Texas Southwestern Medical School, Dallas, TX, USA.
Cardiology Department, Continental Hospitals, Hyderabad, India.
J Hum Hypertens. 2014 Dec;28(12):699-704. doi: 10.1038/jhh.2014.6. Epub 2014 Mar 6.
Severe hypertension (systolic blood pressure (BP) ⩾160 mm Hg) resistant to treatment with multiple antihypertensive medications, poses a serious challenge to therapeutic treatment. Catheter-based renal denervation (RDN) is being increasingly proposed and researched as a safe and effective method of treating this condition. This article evaluates the existing evidence on the effects of RDN on BP reduction and other conditions with increased sympathetic tone. Findings indicate that RDN is a safe and effective treatment for severe hypertension. Moreover, the antihypertensive response to RDN is sustained for up to 3 years of follow-up. RDN decreases office BP more than ambulatory BP, which may be explained by the white-coat effect that causes an increase in office BP. Findings indicate that although reinnervation may occur following RDN, it does not appear to attenuate or reverse the BP response over 24-36 months. There is also evidence that patients with milder forms of hypertension may benefit from RDN. Furthermore, there is emerging evidence that RDN may have a role in the treatment of heart failure, obstructive sleep apnea, insulin resistance, atrial fibrillation and hypertension associated with end-stage renal disease. Taking into account that resistant hypertension and other diseases associated with elevated sympathetic tone are associated with significant morbidity and mortality rates, RDN therapy may be expected to have a significant impact on public health.
严重高血压（收缩压（BP）⩾160 mmHg）对多种抗高血压药物治疗耐药，给治疗带来了严峻挑战。基于导管的肾去神经支配术（RDN）作为一种治疗该疾病的安全有效方法，正越来越多地被提出和研究。本文评估了现有关于RDN对降低血压及其他交感神经张力增加情况的影响的证据。研究结果表明，RDN是治疗严重高血压的一种安全有效方法。此外，RDN的降压反应在长达3年的随访中持续存在。RDN降低诊室血压的幅度大于动态血压，这可能是由导致诊室血压升高的白大衣效应所解释。研究结果表明，尽管RDN后可能会发生神经再生，但在24 - 36个月内似乎不会减弱或逆转血压反应。也有证据表明，轻度高血压患者可能从RDN中获益。此外，新出现的证据表明，RDN可能在心力衰竭、阻塞性睡眠呼吸暂停、胰岛素抵抗、心房颤动以及与终末期肾病相关的高血压的治疗中发挥作用。考虑到难治性高血压和其他与交感神经张力升高相关的疾病与显著的发病率和死亡率相关，预计RDN疗法可能会对公众健康产生重大影响。
