Al-Fakhouri Ahmad, Efeovbokhan Nephertiti, Nakhla Rami, Khouzam Rami N
Department of Medicine, Methodist South Hospital, Memphis, TN, United States.
Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, United States.
Rev Port Cardiol. 2016 Oct;35(10):531-8. doi: 10.1016/j.repc.2016.06.005. Epub 2016 Sep 7.
Hypertension is one of the most common chronic clinical problems encountered by physicians. The prevalence of resistant hypertension is estimated at 9% in the US. Patients with resistant hypertension have been shown to be at higher risk for adverse cardiovascular events, hence the need for greater efforts in improving the treatment of hypertension. The renal sympathetic nerves play an important role in the development of hypertension, mediated via sodium and water retention, increased renin release and alterations in renal blood flow. The proximity of the afferent and efferent renal sympathetic nerves to the adventitia of the renal arteries suggested the feasibility of an endovascular, selective, minimally invasive approach to renal denervation; a potential treatment option for resistant hypertension. While the RAPID, Reduce-HTN, EnligHTN, DENERHTN and Symplicity HTN-1 and -2 studies showed significant benefit of renal denervation in the treatment of resistant hypertension, the results of Oslo RDN, Prague-15 and Symplicity HTN-3 were not so favorable. Future well-designed clinical trials are needed to ascertain the benefits or otherwise of renal denervation in treatment-resistant hypertension.
高血压是医生所面临的最常见的慢性临床问题之一。据估计，美国顽固性高血压的患病率为9%。已证明顽固性高血压患者发生不良心血管事件的风险更高，因此需要加大力度改善高血压的治疗。肾交感神经在高血压的发生发展中起重要作用，其介导机制包括钠水潴留、肾素释放增加以及肾血流量改变。肾传入和传出交感神经与肾动脉外膜相邻，提示了采用血管内、选择性、微创方法进行肾去神经支配的可行性；这是一种治疗顽固性高血压的潜在选择。虽然RAPID、Reduce-HTN、EnligHTN、DENERHTN以及Symplicity HTN-1和-2研究显示肾去神经支配在治疗顽固性高血压方面有显著益处，但Oslo RDN、Prague-15和Symplicity HTN-3研究的结果却不尽人意。未来需要设计完善的临床试验来确定肾去神经支配在治疗抵抗性高血压中的益处或其他情况。
