Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Hypertens Res. 2023 Jun;46(6):1462-1470. doi: 10.1038/s41440-023-01266-2. Epub 2023 Mar 29.
Inappropriate sympathetic activation is closely associated with the development and progression of hypertension. Renal denervation (RDN) is a neuromodulation therapy performed using an intraarterial catheter in patients with hypertension. Recent randomized sham-operated controlled trials have shown that RDN has significant antihypertensive effects that last for at least 3 years. Based on this evidence, RDN is nearly ready for general clinical application. On the other hand, there are remaining issues to be addressed, including elucidation of the precise antihypertensive mechanisms of RDN, the appropriate endpoint of RDN during the procedure, and the association between reinnervation after RDN and the long-term effects of RDN. This mini review focuses on studies implicating anatomy of the renal nerves, which consist of afferent or efferent and sympathetic or parasympathetic nerves, the response of blood pressure to renal nerve stimulation, and reinnervation of renal nerves after RDN. A comprehensive understanding of the anatomical and functional aspects of the renal nerves and the antihypertensive mechanisms of RDN, including its long-term effects, will enhance our ability to incorporate RDN into strategies to treat hypertension in clinical practice. This mini review focuses on studies implicating anatomy of the renal nerves, which consist of afferent or efferent and sympathetic or parasympathetic nerves, the response of blood pressure to renal nerve stimulation, and reinnervation of renal nerves after renal denervation. Whether the ablation site is sympathetic dominant or parasympathetic dominant, and afferent dominant or efferent dominant, would in turn determine the final output of renal denervation. BP: blood pressure.
不适当的交感神经激活与高血压的发生和进展密切相关。肾去神经术（RDN）是一种使用动脉内导管在高血压患者中进行的神经调节治疗。最近的随机假手术对照试验表明，RDN 具有显著的降压作用，至少持续 3 年。基于这一证据，RDN 几乎可以准备进行一般的临床应用。另一方面，仍有一些问题需要解决，包括阐明 RDN 的精确降压机制、RDN 过程中的适当终点以及 RDN 后再神经支配与 RDN 的长期效果之间的关系。这篇迷你综述重点介绍了涉及肾神经解剖结构的研究，包括传入或传出神经和交感或副交感神经，血压对肾神经刺激的反应，以及 RDN 后肾神经的再神经支配。全面了解肾神经的解剖和功能方面以及 RDN 的降压机制，包括其长期效果，将提高我们将 RDN 纳入治疗高血压的临床实践策略的能力。这篇迷你综述重点介绍了涉及肾神经解剖结构的研究，包括传入或传出神经和交感或副交感神经，血压对肾神经刺激的反应，以及 RDN 后肾神经的再神经支配。肾去神经术的消融部位是交感神经占主导还是副交感神经占主导，传入神经占主导还是传出神经占主导，反过来又会决定肾去神经术的最终输出。BP：血压。
