Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa.
Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pa.
Am J Med. 2023 Sep;136(9):857-868. doi: 10.1016/j.amjmed.2023.05.010. Epub 2023 May 23.
Renal denervation is not a cure for hypertension. Although more recent sham-controlled trials were positive, a significant minority of patients in each trial were unresponsive. The optimal patient or patients need to be defined. Combined systolic/diastolic hypertension appears more responsive than isolated systolic hypertension. It remains uncertain whether patients with comorbidities associated with higher adrenergic tone should be targeted, including obesity, diabetes, sleep apnea, and chronic kidney disease. No biomarker can adequately predict response. A key to a successful response is the adequacy of denervation, which currently cannot be assessed in real time. It is uncertain what is the optimal denervation methodology: radiofrequency, ultrasound, or ethanol injection. Radiofrequency requires targeting the distal main renal artery plus major branches and accessory arteries. Although denervation appears to be safe, conclusive data on quality of life, improved target organ damage, and reduced cardiovascular events/mortality are required before denervation can be generally recommended.
肾动脉去神经术不是高血压的治愈方法。尽管最近的假手术对照试验结果为阳性，但每个试验中仍有相当一部分患者没有反应。需要确定最佳的患者人群。收缩压/舒张压高血压比单纯收缩期高血压更有反应。目前仍不确定是否应该针对与更高去甲肾上腺素能张力相关的合并症患者进行治疗，包括肥胖、糖尿病、睡眠呼吸暂停和慢性肾脏病。没有生物标志物可以充分预测反应。成功反应的关键是去神经支配的充分性，目前无法实时评估。目前尚不确定最佳的去神经支配方法是什么：射频、超声还是乙醇注射。射频需要针对远端主肾动脉及其主要分支和副动脉进行治疗。尽管去神经支配似乎是安全的，但在广泛推荐去神经支配之前，还需要有关于生活质量、改善靶器官损伤以及减少心血管事件/死亡率的明确数据。
