Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany.
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany; Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA.
Prog Cardiovasc Dis. 2021 Mar-Apr;65:76-83. doi: 10.1016/j.pcad.2021.02.005. Epub 2021 Feb 13.
Despite the availability of safe and effective antihypertensive drugs, blood pressure (BP) control to guideline-recommended target values is poor. Several device-based therapies have been introduced to lower BP. The most extensively investigated approach is catheter-based renal sympathetic denervation (RDN), which aims to interrupt the activity of afferent and efferent renal sympathetic nerves by applying radiofrequency energy, ultrasound energy, or injection of alcohol in the perivascular space. The second generation of placebo-controlled trials have provided solid evidence for the BP-lowering efficacy of radiofrequency- and ultrasound-based RDN in patients with and without concomitant pharmacological therapy. In addition, the safety profile of RDN appears to be excellent in all registries and clinical trials. However, there remain unsolved issues to be addressed. This review summarizes the rationale as well as the current evidence and discusses open questions and possible future indications of catheter-based RDN.
尽管有安全有效的降压药物可用，但血压（BP）控制达到指南推荐的目标值仍然不佳。已经引入了几种基于设备的治疗方法来降低 BP。研究最广泛的方法是基于导管的肾交感神经去神经（RDN），其目的是通过在血管周围空间应用射频能量、超声能量或注射酒精来中断传入和传出肾交感神经的活动。第二代安慰剂对照试验为射频和基于超声的 RDN 在伴有和不伴有伴随药物治疗的患者中降低 BP 的疗效提供了确凿的证据。此外，RDN 的安全性在所有登记处和临床试验中似乎都非常出色。然而，仍存在需要解决的未决问题。这篇综述总结了基于导管的 RDN 的基本原理以及当前的证据，并讨论了开放问题和可能的未来适应证。
