Hiremath Swapnil, Froeschl Michael, Ruzicka Marcel
aDivision of Nephrology, Faculty of Medicine, University of Ottawa bClinical Epidemiology Program, Ottawa Hospital Research Institute cDivision of Cardiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Curr Opin Cardiol. 2014 Jul;29(4):336-43. doi: 10.1097/HCO.0000000000000076.
Renal sympathetic nerves play a significant role in the development and maintenance of hypertension. Percutaneous catheter-based radioablation of the sympathetic nerves around the renal arteries is a true innovation in follow up to prior animal studies. In this opinion article, we will review the role of the renal sympathetic network in hypertension, and the evidence (or the lack of it) for renal sympathetic denervation as a treatment modality for human hypertension.
Over the last 5 years, path-breaking research has raised the promise of a dramatically effective therapy for treatment of resistant hypertension in the form of renal sympathetic denervation. Unfortunately, on the basis of limited proof-of-concept and prospective observational studies, this method was widely perceived as a proven therapy for resistant hypertension. As we have learnt from history, only properly designed prospective randomized controlled trials can tell whether that is indeed the truth.
Catheter-based renal sympathetic denervation, despite the recent setbacks, remains a novel and innovative therapeutic intervention, which may still have a role to play in the treatment of carefully selected patients with truly resistant hypertension. Mechanistic studies designed to address the cause of the blood pressure response (or lack thereof) to renal denervation are the next logical step. However, the long-term implications of renal denervation, especially safety issues with respect to the lack of renal sympathetic response in times of physiological need, are not well understood.
肾交感神经在高血压的发生和维持中起重要作用。基于经皮导管的肾动脉周围交感神经射频消融术是继先前动物研究之后的一项真正创新。在这篇观点文章中，我们将回顾肾交感神经网络在高血压中的作用，以及肾交感神经去神经支配作为人类高血压治疗方式的证据（或缺乏证据的情况）。
在过去5年中，开创性研究带来了以肾交感神经去神经支配形式治疗顽固性高血压的显著有效疗法的希望。不幸的是，基于有限的概念验证和前瞻性观察性研究，这种方法被广泛视为一种已证实的顽固性高血压治疗方法。从历史中我们了解到，只有经过适当设计的前瞻性随机对照试验才能确定这是否真的如此。
基于导管的肾交感神经去神经支配尽管最近遭遇挫折，但仍然是一种新颖且创新的治疗干预措施，在精心挑选的真正顽固性高血压患者的治疗中可能仍有作用。旨在解决肾去神经支配后血压反应（或无反应）原因的机制研究是下一步合理举措。然而，肾去神经支配的长期影响，尤其是在生理需求时缺乏肾交感反应的安全性问题，尚未得到充分理解。
