Burchell Amy E, Chan Kenneth, Ratcliffe Laura E K, Hart Emma C, Saxena Manish, Collier David J, Jain Ajay K, Mathur Anthony, Knight Charles J, Caulfield Mark J, Paton Julian F R, Nightingale Angus K, Lobo Melvin D, Baumbach Andreas
CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK.
School of Clinical Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, UK.
J Clin Hypertens (Greenwich). 2016 Jun;18(6):585-92. doi: 10.1111/jch.12789. Epub 2016 Feb 9.
Renal denervation (RDN) is a therapy that targets treatment-resistant hypertension (TRH). The Renal Denervation in Patients With Uncontrolled Hypertension (Symplicity) HTN-1 and Symplicity HTN-2 trials reported response rates of >80%; however, sham-controlled Symplicity HTN-3 failed to reach its primary blood pressure (BP) outcome. The authors address the current controversies surrounding RDN, illustrated with real-world data from two centers in the United Kingdom. In this cohort, 52% of patients responded to RDN, with a 13±32 mm Hg reduction in office systolic BP (SBP) at 6 months (n=29, P=.03). Baseline office SBP and number of ablations correlated with office SBP reduction (R=-0.47, P=.01; R=-0.56, P=.002). RDN appears to be an effective treatment for some patients with TRH; however, individual responses are highly variable. Selecting patients for RDN is challenging, with only 10% (33 of 321) of the screened patients eligible for the study. Medication alterations and nonadherence confound outcomes. Adequate ablation is critical and should impact future catheter design/training. Markers of procedural success and improved patient selection parameters remain key research aims.
肾去神经支配术（RDN）是一种针对难治性高血压（TRH）的治疗方法。肾去神经支配术治疗未控制高血压患者（Symplicity）的HTN - 1和Symplicity HTN - 2试验报告的有效率>80%；然而，采用假手术对照的Symplicity HTN - 3试验未能达到其主要血压（BP）目标。作者利用来自英国两个中心的真实世界数据阐述了当前围绕RDN的争议。在该队列中，52%的患者对RDN有反应，6个月时诊室收缩压（SBP）降低了13±32 mmHg（n = 29，P = 0.03）。基线诊室SBP和消融次数与诊室SBP降低相关（R = -0.47，P = 0.01；R = -0.56，P = 0.002）。RDN似乎对一些TRH患者是一种有效的治疗方法；然而，个体反应差异很大。选择适合RDN的患者具有挑战性，在筛查的患者中只有10%（321例中的33例）符合研究条件。药物调整和不依从会混淆结果。充分的消融至关重要，并且应该影响未来导管的设计/培训。手术成功的标志物和改进的患者选择参数仍然是关键的研究目标。
