Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Hypertens Res. 2023 Apr;46(4):898-912. doi: 10.1038/s41440-022-01133-6. Epub 2023 Feb 9.
Hypertension remains a significant risk factor for major cardiovascular events worldwide. Poor adherence to treatment is extremely common in clinical practice, leading to uncontrolled hypertension. However, some patients with resistant hypertension still have uncontrolled blood pressure despite good medical compliance. A specific group of patients also develop adverse reactions to many blood pressure-lowering medications. These scenarios indicate that innovative strategies to lower blood pressure in challenging cases of hypertension are needed. The blood pressure-lowering efficacy of catheter-based renal denervation therapy to decrease sympathetic tone has been confirmed in many publications in recent years. Apart from both the invasiveness and the expensiveness of this technology, appropriate case selection to undergo this procedure is still developing. The utilization of renal denervation therapy for hypertension treatment in Thailand has lasted for 10 years with a good response in most cases. Currently, only certain interventionists at a few medical schools in Thailand can perform this procedure. However, more physicians are now interested in applying this technology to their patients. The Thai Hypertension Society Committee has reviewed updated information to provide principles for the appropriate utilization of renal denervation therapy. The blood pressure-lowering mechanism, efficacy, suitable patient selection, pre- and postprocedural assessment and procedural safety of renal denervation are included in this statement.
高血压仍然是全球主要心血管事件的重要危险因素。在临床实践中，治疗依从性差极为常见，导致高血压无法得到控制。然而，一些抗药性高血压患者即使有良好的医疗依从性，血压仍无法得到控制。还有一些特定的患者对许多降压药物会产生不良反应。这些情况表明，需要针对高血压的挑战性病例制定创新的降压策略。近年来，多项出版物证实了经导管肾去神经治疗降低交感神经张力以降低血压的疗效。除了该技术的侵袭性和昂贵性外，适当的病例选择以进行该手术仍在不断发展中。在泰国，肾去神经治疗高血压的应用已经持续了 10 年，大多数情况下都有良好的反应。目前，泰国只有少数几所医学院的少数介入医生可以进行该手术。然而，现在有更多的医生对将该技术应用于其患者感兴趣。泰国高血压学会委员会审查了更新的信息，为肾去神经治疗的合理应用提供了原则。本声明包括肾去神经的降压机制、疗效、合适的患者选择、术前和术后评估以及手术安全性。
