Washington Veterans Affairs Medical Center, 50 Irving Street, N.W., Washington, DC, 20422, USA.
Georgetown University Hospital, Washington, DC, USA.
Curr Hypertens Rep. 2016 Aug;18(8):64. doi: 10.1007/s11906-016-0671-4.
Drug-resistant hypertension (RH) remains a significant and common cardiovascular risk despite the availability of multiple potent antihypertensive medications. Uncontrolled resistant hypertension contributes substantially to excessive cardiovascular and renal morbidity and mortality. Clinical and experimental evidence suggest that sympathetic nervous system over-activity is the main culprit for the development and maintenance of drug-resistant hypertension. Both medical and interventional strategies, targeting the sympathetic over-activation, have been designed in patients with hypertension over the past few decades. Minimally invasive, catheter-based, renal sympathetic denervation (RDN) and carotid baroreceptor activation therapy (BAT) have been extensively evaluated in patients with RH in clinical trials. Current trial outcomes, though at times impressive, have been mostly uncontrolled trials in need of validation. Device-based therapy for drug-resistant hypertension has the potential to provide alternative treatment options to certain groups of patients who are refractory or intolerant to current antihypertensive medications. However, more research is needed to prove its efficacy in both animal models and in humans. In this article, we will review the evidence from recent renal denervation, carotid baroreceptor stimulation therapy, and newly emerged central arteriovenous anastomosis trials to pinpoint the weak links, and speculate on potential alternative approaches.
尽管有多种强效降压药物可用，但耐药性高血压（RH）仍然是一个重大且常见的心血管风险。未得到控制的耐药性高血压会大大增加心血管和肾脏发病率和死亡率。临床和实验证据表明，交感神经系统过度活跃是耐药性高血压发展和维持的主要罪魁祸首。在过去几十年中，针对高血压患者的交感神经过度激活，已经设计了多种医疗和介入策略。微创、基于导管的肾交感神经切除术（RDN）和颈动脉压力感受器刺激疗法（BAT）已在 RH 患者的临床试验中得到广泛评估。尽管目前的试验结果有时令人印象深刻，但大多是需要验证的非对照试验。针对耐药性高血压的设备治疗有可能为某些对当前降压药物不耐受或无反应的患者提供替代治疗选择。然而，还需要更多的研究来证明其在动物模型和人类中的疗效。本文将回顾最近的肾去神经支配、颈动脉压力感受器刺激治疗和新出现的中枢动静脉吻合术试验的证据，以找出薄弱环节，并推测潜在的替代方法。
