Department of Medicine, Division of Nephrology and Hypertension.
Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota, USA.
Curr Opin Nephrol Hypertens. 2023 Sep 1;32(5):404-411. doi: 10.1097/MNH.0000000000000908. Epub 2023 Jun 30.
Renal denervation represents a new dimension to hypertension treatment, with multiple device manufacturers seeking premarket FDA approval currently. Interest in the efficacy and safety of the treatment has spurred compelling mechanistic studies into the function of renal nerves and downstream impacts of denervation.
A trial of the ultrasound Paradise Catheter system (RADIANCE II) found a 6.3 mmHg reduction in SBP relative to sham controls. A trial of the Symplicity Spyral system (SPYRAL HTN-ON MED) found an insignificant reduction in SBP relative to sham controls. Individuals were taking antihypertensive medications during the study, and investigators note the sham group experienced a larger medication burden than the denervated group. Recent preclinical studies have evaluated potential risks of renal denervation, how sympathetic activity broadly is affected, as well as identifying possible biomarkers to identify individuals where denervation would be more successful.
Studies of renal denervation continue to find a robust antihypertensive effect, especially in studies wherein medications are withdrawn. Further investigation into mechanisms and indicators for usage of the technique will be important in identifying the patient population most likely to benefit from usage of renal denervation.
肾去神经术代表了高血压治疗的一个新维度，目前有多家设备制造商正在寻求美国食品药品监督管理局（FDA）的上市前批准。人们对该治疗方法的疗效和安全性产生了浓厚的兴趣，这促使人们对肾脏神经的功能及其去神经支配的下游影响进行了引人注目的机制研究。
一项使用超声 Paradise 导管系统（RADIANCE II）的试验发现，与假手术对照组相比，收缩压（SBP）降低了 6.3mmHg。一项使用 Symplicity Spyral 系统（SPYRAL HTN-ON MED）的试验发现，与假手术对照组相比，SBP 无显著降低。在研究期间，参与者正在服用抗高血压药物，研究人员注意到假手术组的药物负担比去神经支配组大。最近的临床前研究评估了肾去神经术的潜在风险、交感神经活动的广泛影响，以及确定可能的生物标志物，以识别去神经术更可能成功的个体。
肾去神经术的研究继续发现其具有强大的降压作用，尤其是在停药的研究中。进一步研究该技术的机制和使用指标，对于确定最有可能从肾去神经术获益的患者群体将非常重要。
