Kardiol Pol. 2018;76(7):1031-1042. doi: 10.5603/KP.a2018.0129. Epub 2018 Jun 15.
The publication of the first non-randomised proof-of-concept trial of renal denervation as a treatment modality in treatment- -resistant hypertension set the stage for a search for novel devices with the expectation that technology would reduce the burden of hypertension by reducing or eliminating the costly and lifelong use of blood pressure-lowering medications. As we demonstrate in this review, this idea was so attractive to manufacturers and invasive cardiologists and radiologists that they overlooked decades of careful pathophysiological research in a disease that remains enigmatic but is still a major cause of cardio-vascular mortality worldwide. To make our point, we first reviewed the prevalence and risks associated with treatment-resistant hypertension. Next, we highlighted the key points required for the diagnosis of treatment-resistant hypertension, including the recording of ambulatory blood pressure and the assessment of adherence to medication. Finally, we summarised new insights in the management of treatment-resistant hypertension by medication and devices as well as in future research. Throughout our review, we focused on new evidence that had become available since 2013. Our conclusion is that optimising medical treatment based on simple algorithms remains the state of the art in treatment-resistant hypertension.
第一篇关于肾去神经术作为一种治疗抵抗性高血压的治疗方法的非随机概念验证试验的发表，为寻找新的治疗设备奠定了基础，人们期望这些设备能够通过减少或消除昂贵且终身使用的降压药物，从而减轻高血压的负担。正如我们在这篇综述中所展示的那样，这个想法对制造商和介入心脏病学家和放射科医生来说是如此具有吸引力，以至于他们忽视了数十年来对这种仍然神秘但仍是全球心血管死亡率主要原因的疾病的精心病理生理学研究。为了说明我们的观点，我们首先回顾了治疗抵抗性高血压的患病率和相关风险。接下来，我们强调了诊断治疗抵抗性高血压所需的关键点，包括动态血压监测和药物依从性评估。最后，我们总结了治疗抵抗性高血压在药物和设备治疗以及未来研究方面的新见解。在整个综述中，我们重点介绍了自 2013 年以来出现的新证据。我们的结论是，基于简单算法的优化药物治疗仍然是治疗抵抗性高血压的最新技术。
