Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, University of Western Australia and Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia.
Neurovascular Hypertension & Kidney Disease Laboratory and Human Neurotransmitter Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
J Am Coll Cardiol. 2019 Jun 18;73(23):3006-3017. doi: 10.1016/j.jacc.2019.04.015.
Three recent renal denervation studies in both drug-naïve and drug-treated hypertensive patients demonstrated a significant reduction of ambulatory blood pressure compared with respective sham control groups. Improved trial design, selection of relevant patient cohorts, and optimized interventional procedures have likely contributed to these positive findings. However, substantial variability in the blood pressure response to renal denervation can still be observed and remains a challenging and important problem. The International Sympathetic Nervous System Summit was convened to bring together experts in both experimental and clinical medicine to discuss the current evidence base, novel developments in our understanding of neural interplay, procedural aspects, monitoring of technical success, and others. Identification of relevant trends in the field and initiation of tailored and combined experimental and clinical research efforts will help to address remaining questions and provide much-needed evidence to guide clinical use of renal denervation for hypertension treatment and other potential indications.
三项最近的肾去神经治疗研究,无论是在药物初治还是药物治疗的高血压患者中,与各自的假手术对照组相比,均显示出显著降低的动态血压。改进的试验设计、相关患者队列的选择和优化的介入程序可能促成了这些积极的发现。然而,肾去神经治疗对血压的反应仍存在很大的变异性,这仍然是一个具有挑战性和重要的问题。国际交感神经系统峰会的召开是为了汇集实验和临床医学方面的专家,讨论目前的证据基础、我们对神经相互作用的新认识、程序方面、技术成功的监测等方面的新进展。确定该领域的相关趋势,并开展有针对性的、结合实验和临床研究的努力,将有助于解决遗留问题,并提供急需的证据,以指导肾去神经治疗高血压及其他潜在适应证的临床应用。