Groenland Eline H, Spiering Wilko
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, 3508, GA, Utrecht, The Netherlands.
Curr Hypertens Rep. 2020 Mar 12;22(4):27. doi: 10.1007/s11906-020-1024-x.
Patients with true resistant hypertension (RH) are characterized by having high sympathetic activity and therefore potentially benefit from treatments such as baroreflex amplification (baroreflex activation therapy (BAT) or endovascular baroreflex amplification therapy (EVBA)) or carotid body (CB) modulation. This review aims at providing an up-to-date overview of the available evidence regarding these two therapies.
In recent years, increasing evidence has confirmed the potential of baroreflex amplification, either electrically (Barostim neo) or mechanically (MobiusHD), to improve blood pressure control on short- and long-term with only few side effects, in patients with RH. Two studies regarding unilateral CB resection did not show a significant change in blood pressure. Only limited studies regarding CB modulation showed promising results for transvenous CB ablation, but not for unilateral CB resection. Despite promising results from mostly uncontrolled studies, more evidence regarding the safety and efficacy from ongoing large randomized sham-controlled trials is needed before baroreflex amplification and CB modulation can be implemented in routine clinical practice.
真正的顽固性高血压（RH）患者的特征是交感神经活动亢进，因此可能从压力反射增强（压力反射激活疗法（BAT）或血管内压力反射增强疗法（EVBA））或颈动脉体（CB）调节等治疗中获益。本综述旨在提供有关这两种疗法的现有证据的最新概述。
近年来，越来越多的证据证实，无论是通过电刺激（Barostim neo）还是机械刺激（MobiusHD）进行压力反射增强，都能够在短期和长期内改善RH患者的血压控制，且副作用较少。两项关于单侧CB切除术的研究未显示血压有显著变化。关于CB调节的研究有限，经静脉CB消融显示出有前景的结果，但单侧CB切除术则不然。尽管大多数非对照研究取得了有前景的结果，但在压力反射增强和CB调节能够在常规临床实践中应用之前，仍需要正在进行的大型随机假对照试验提供更多关于安全性和有效性的证据。
