Reyes Klevin Roger L, Rader Florian
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Integr Blood Press Control. 2023 Sep 7;16:59-70. doi: 10.2147/IBPC.S392410. eCollection 2023.
Hypertension is the most potent modifiable risk factor for the development of cardiovascular morbidity and mortality worldwide. Nevertheless, blood pressure (BP) control on a broad scale appears to be insurmountable and has even worsened in the US. Barriers to sustained hypertension control are multifactorial and although lack of patient awareness and socioeconomic barriers to healthcare access may play a role, medication non-compliance and therapeutic inertia are major causes. Renal denervation (RDN) is a minimally invasive procedure that has been the subject of interest in clinical trials for more than a decade and although the first sham-controlled trial could not detect group difference between treated and untreated hypertensives, subsequent, better designed sham-controlled trials clearly demonstrated the BP lowering effect of RDN, as well as its safety. While to-date, RDN is not available for routine clinical practice, one major requirement for broad implementation is that the BP lowering effect is durable. Therefore, this review will summarize the available long-term data of the different RDN modalities with respect to both effectiveness and safety.
高血压是全球范围内导致心血管疾病发病和死亡的最主要可改变风险因素。然而，大规模的血压（BP）控制似乎难以实现，在美国甚至有所恶化。持续控制高血压存在多方面障碍，尽管患者意识不足以及获得医疗保健的社会经济障碍可能起到一定作用，但药物治疗依从性差和治疗惰性是主要原因。肾去神经支配术（RDN）是一种微创手术，十多年来一直是临床试验关注的对象。尽管首个假手术对照试验未能检测出治疗组和未治疗组高血压患者之间的组间差异，但随后设计更完善的假手术对照试验清楚地证明了RDN的降压效果及其安全性。虽然迄今为止，RDN尚未用于常规临床实践，但广泛应用的一个主要要求是降压效果持久。因此，本综述将总结不同RDN术式在有效性和安全性方面的现有长期数据。
