From the Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tokyo, Japan (K.K.).
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (B.-K.K.).
Hypertension. 2020 Mar;75(3):590-602. doi: 10.1161/HYPERTENSIONAHA.119.13671. Epub 2020 Feb 3.
The Asia Renal Denervation Consortium consensus conference of Asian physicians actively performing renal denervation (RDN) was recently convened to share up-to-date information and regional perspectives, with the goal of consensus on RDN in Asia. First- and second-generation trials of RDN have demonstrated the efficacy and safety of this treatment modality for lowering blood pressure in patients with resistant hypertension. Considering the ethnic differences of the hypertension profile and demographics of cardiovascular disease demonstrated in the SYMPLICITY HTN (Renal Denervation in Patients With Uncontrolled Hypertension)-Japan study and Global SYMPLICITY registry data from Korea and Taiwan, RDN might be an effective hypertension management strategy in Asia. Patient preference for device-based therapy should be considered as part of a shared patient-physician decision process. A practical population for RDN treatment could consist of Asian patients with uncontrolled essential hypertension, including resistant hypertension. Opportunities to refine the procedure, expand the therapy to other sympathetically mediated diseases, and explore the specific effects on nocturnal and morning hypertension offer a promising future for RDN. Based on available evidence, RDN should not be considered a therapy of last resort but as an initial therapy option that may be applied alone or as a complementary therapy to antihypertensive medication.
亚洲去肾交感神经术联盟(Asia Renal Denervation Consortium)的亚洲术者共识会议最近召开,旨在分享最新信息和区域观点,以期在亚洲达成去肾交感神经术的共识。第一代和第二代去肾交感神经术试验已经证明了这种治疗方式在降低难治性高血压患者血压方面的疗效和安全性。考虑到 SYMPLICITY HTN(去肾交感神经术治疗未控制高血压患者)-日本研究和韩国及中国台湾地区的全球 SYMPLICITY 注册数据中显示的高血压特征和心血管疾病人口统计学的种族差异,去肾交感神经术可能是亚洲有效的高血压管理策略。患者对设备治疗的偏好应作为医患共同决策过程的一部分来考虑。去肾交感神经术的实际治疗人群可能包括亚洲未控制的原发性高血压患者,包括难治性高血压患者。对该手术的完善机会、将该治疗方法扩展到其他交感神经介导的疾病以及探索其对夜间和清晨高血压的具体影响,为去肾交感神经术的未来提供了广阔的前景。基于现有证据,去肾交感神经术不应被视为最后的治疗选择,而应作为初始治疗选择,可单独应用或作为降压药物的补充治疗。