Camafort Miguel, Ihm Sang Hyun, Ruilope Luis Miguel
Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona.
CIBER-OBN. ISCIII Madrid.
Curr Opin Nephrol Hypertens. 2023 Nov 1;32(6):544-550. doi: 10.1097/MNH.0000000000000928. Epub 2023 Sep 13.
Hypertension is a condition characterized by increased sympathetic activity and the autonomic nervous system. Resistant hypertension, a condition with a prevalence of 10% to 20% in the general hypertensive population, is more likely to experience poor outcomes and adverse cardiovascular events. Renal sympathetic denervation (RDN), a minimally invasive, catheter-based percutaneous intervention, has been considered for treating this condition. Clinical trials have used various catheters, such as the Symplicity Spyral catheter, Vessix Renal Denervation system, and Paradise endovascular ultrasound renal denervation system.
After the first randomized clinical trials examining the effectiveness and safety of RDN for lowering blood pressure in hypertensive patients, new clinical trials have used various catheters based on radiofrequency, such as the Spyral catheter, Vessix Renal Denervation system, or based on radiofrequency as the Paradise endovascular ultrasound renal denervation system. Positive results on this trials have shown that endovascular RDN (radiofrequency energy or high focused ultrasound energy) could be considered as a treatment option for uncontrolled resistant hypertension.
Therefore, endovascular RDN (radiofrequency energy or high focused ultrasound energy) could be considered as a treatment option for uncontrolled resistant hypertension, which can be considered as an alternative to increasing medication. Nevertheless more data are needed, mainly in cardiovascular outcomes. RDN should be performed in experienced and specialized centers with a multidisciplinary team, and the benefits and risks of RDN should be addressed in a shared-decision-making process.
高血压是一种以交感神经活动增加和自主神经系统异常为特征的疾病。难治性高血压在普通高血压人群中的患病率为10%至20%，更易出现不良预后和心血管不良事件。肾交感神经消融术（RDN）是一种基于导管的微创经皮介入治疗方法，已被考虑用于治疗这种疾病。临床试验使用了各种导管，如Symplicity Spyral导管、Vessix肾去神经支配系统和Paradise血管内超声肾去神经支配系统。
在首次对RDN降低高血压患者血压的有效性和安全性进行的随机临床试验之后，新的临床试验使用了各种基于射频的导管，如Spyral导管、Vessix肾去神经支配系统，或基于射频的Paradise血管内超声肾去神经支配系统。这些试验的阳性结果表明，血管内RDN（射频能量或高聚焦超声能量）可被视为治疗难治性高血压的一种选择。
因此，血管内RDN（射频能量或高聚焦超声能量）可被视为治疗难治性高血压的一种选择，可被视为增加药物治疗之外的替代方法。然而，还需要更多数据，主要是关于心血管结局的数据。RDN应在有经验的专业中心由多学科团队进行，并且RDN的益处和风险应在共同决策过程中加以探讨。
