Shah Riya Tejas, Wang Brian Xiangzhi
Department of Medicine, King's College London, London, UK.
Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.
Clin Hypertens. 2022 Apr 15;28(1):11. doi: 10.1186/s40885-022-00194-6.
Catheter-based renal denervation has been studied as a potential therapeutic option to reduce high blood pressure (BP). Preclinical studies in some experimental models have demonstrated an antihypertensive effect of renal denervation but reports from clinical trials have been mixed METHODS: We performed a literature search using combinations of the key terms 'Cardiovascular diseases, Clinical trial, Pre-clinical trials, Resistant hypertension, Renal denervation, Ablation technique, Radiofrequency ablation, Ultrasound ablation, RADIANCE SOLO, SYMPLICITY HTN, SYPRAL HTN'. The databases searched were PubMed and OVID Medline.
The initial SYMPLICITY HTN-1 AND HTN-2 clinical trials reported significant decreases in office BP but results from the more robustly designed SYMPLICITY HTN-3 trial, which included sham controls and ambulatory BP monitoring, showed no significant antihypertensive effect. Interest in the use of renal denervation in hypertension was once again sparked by favourable results from the SPYRAL HTN-OFF Med trial CONCLUSION: We provide a thorough, critical analysis of key preclinical and clinical studies investigating the efficacy of catheter-based renal denervation as a treatment for hypertension and highlight future areas for research to allow better translation into clinical practice.
基于导管的肾去神经术已被作为降低高血压(BP)的一种潜在治疗选择进行研究。在一些实验模型中的临床前研究已证明肾去神经术具有降压作用,但临床试验的报告结果不一。方法:我们使用关键词“心血管疾病、临床试验、临床前试验、顽固性高血压、肾去神经术、消融技术、射频消融、超声消融、RADIANCE SOLO、SYMPLICITY HTN、SYPRAL HTN”的组合进行文献检索。检索的数据库为PubMed和OVID Medline。
最初的SYMPLICITY HTN-1和HTN-2临床试验报告诊室血压显著降低,但设计更完善的SYMPLICITY HTN-3试验(包括假手术对照和动态血压监测)结果显示无显著降压效果。SPYRAL HTN-OFF Med试验的良好结果再次引发了对肾去神经术治疗高血压的兴趣。结论:我们对研究基于导管的肾去神经术治疗高血压疗效的关键临床前和临床研究进行了全面、批判性分析,并突出了未来的研究领域,以便更好地转化为临床实践。