Brandon Lisa, Sharif Faisal
Department of Cardiology, University Hospital Galway, Galway, Ireland.
Interv Cardiol. 2016 May;11(1):65-69. doi: 10.15420/icr.2016:3:1.
Resistant hypertension remains a clinical challenge with few management options beyond maximisation of medications. Catheter- based renal artery denervation (RDN) was proposed in 2009 as a possible therapy for resistant hypertension and early feasibility trials caused excitement among cardiologists and antihypertensive specialists, showing remarkable and sustained blood pressure reductions. In 2014, enthusiasm for RDN dampened following the SYMPLICITY 3 trial results, which showed no statistically significant difference in blood pressure between the intervention and control arms. However, hope remains for the improved management of resistant hypertension; procedural understanding, technological advancements and alternative targets - such as baroreceptor activation therapy and arteriovenous shunts - may aid the identification of those patients for whom specific interventional therapies will be effective.
顽固性高血压仍然是一项临床挑战,除了最大限度地使用药物外,几乎没有其他治疗选择。基于导管的肾动脉去神经支配术(RDN)于2009年被提出,作为治疗顽固性高血压的一种可能方法,早期可行性试验在心脏病专家和抗高血压专家中引起了轰动,显示出显著且持续的血压降低。2014年,在SYMPLICITY 3试验结果公布后,对RDN的热情有所降温,该试验结果显示干预组和对照组之间的血压没有统计学上的显著差异。然而,对于改善顽固性高血压的治疗仍抱有希望;对手术的理解、技术进步以及替代靶点——如压力感受器激活疗法和动静脉分流术——可能有助于识别那些特定介入治疗有效的患者。