Curr Probl Cardiol. 2021 Mar;46(3):100598. doi: 10.1016/j.cpcardiol.2020.100598. Epub 2020 May 3.
In 2017, the American College of Cardiology and American Heart Association released its updated blood pressure guidelines, redefining hypertension to be any systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg. Among United States adults, these new parameters increased the prevalence of hypertension from 72.2 million (31.9%) to 103.3 million (45.6%) adults and decreased the rate of medication-controlled hypertension from 53.4% to 39% with the prevalence of resistant hypertension ranging from 12% to 18%. Results of the pivotal SPRINT trial showed that more intensive blood pressure control in diabetic patients decreased both cardiovascular events and all-cause mortality. However, even with ideal goals in mind, compliance remains an issue due to multiple causes, and approximately half of study participants had stopped taking their antihypertensive drug within a year. Renal sympathetic denervation is a process in which catheter-based techniques are used to ablate specific portions of the renal artery nerves with the goal of decreasing sympathetic nerve activity and reducing blood pressure. Several studies using renal artery denervation have already shown benefit in patients with resistant hypertension, and now newer trials are beginning to focus on those with stage II hypertension as an additional potential treatment population. This review will seek to summarize the current evidence surrounding renal artery denervation and discuss some of its future trials, current issues, and potential roles both in hypertension and other comorbidities.
2017 年，美国心脏病学会和美国心脏协会发布了其更新的血压指南，将高血压重新定义为收缩压≥130mmHg 或舒张压≥80mmHg。在美国成年人中，这些新参数使高血压的患病率从 7220 万人（31.9%）增加到 1.033 亿人（45.6%），药物控制的高血压患病率从 53.4%下降到 39%，而耐药性高血压的患病率从 12%到 18%不等。关键性 SPRINT 试验的结果表明，糖尿病患者更积极的血压控制可降低心血管事件和全因死亡率。然而，即使考虑到理想的目标，由于多种原因，依从性仍然是一个问题，大约一半的研究参与者在一年内停止服用降压药物。肾交感神经切除术是一种使用基于导管的技术来消融肾动脉神经的特定部分的过程，目的是降低交感神经活动并降低血压。几项使用肾动脉去神经支配的研究已经表明，在耐药性高血压患者中具有获益，现在新的试验开始关注作为另一个潜在治疗人群的 II 期高血压患者。这篇综述将总结目前围绕肾动脉去神经支配的证据，并讨论其未来的一些试验、当前的问题以及在高血压和其他合并症中的潜在作用。
