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[高血压患者肾交感神经去神经支配的现状]

[The current state of renal sympathetic denervation in hypertension].

作者信息

Gómez-Rosero Jaime A, Duque-González Laura, Senior-Sánchez Juan M

机构信息

Departamento de Cardiología, Facultad de Medicina, Universidad CES, Medellín, Colombia.

Departamento de Cardiología, Hospital San Vicente Fundación Rionegro, Rionegro, Colombia.

出版信息

Arch Cardiol Mex. 2024 Feb 15;94(3):366-372. doi: 10.24875/ACM.23000191.

DOI:10.24875/ACM.23000191
PMID:38359455
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11259422/
Abstract

This review provides an overview of the efficacy and safety of renal sympathetic denervation as a therapeutic approach for resistant hypertension. While the initial enthusiasm was sparked by the results of early clinical trials, it was dampened by the findings of the Symplicity HTN-3 study. However, recent advances in catheter technology and more refined patient selection criteria have yielded more promising results. Subsequent studies, such as SPYRAL HTN-OFF MED and RADIANCE II, demonstrated significant reductions in blood pressure, even in patients with mild to moderate hypertension. Despite the lack of robust data on major clinical outcomes, investigations into the time in therapeutic range for patients undergoing renal sympathetic denervation suggested potential cardiovascular benefits. Nevertheless, further research is needed to thoroughly understand the long-term impact, assess cost-effectiveness, and accurately identify which patient subgroups may derive the greatest benefits from this therapy.

摘要

本综述概述了肾交感神经去神经术作为难治性高血压治疗方法的疗效和安全性。虽然早期临床试验结果引发了最初的热情,但Symplicity HTN-3研究结果使其热情受挫。然而,导管技术的最新进展和更精细的患者选择标准产生了更有前景的结果。随后的研究,如SPYRAL HTN-OFF MED和RADIANCE II,表明即使是轻度至中度高血压患者,血压也有显著降低。尽管缺乏关于主要临床结局的有力数据,但对接受肾交感神经去神经术患者的治疗范围内时间的调查表明可能有心血管益处。尽管如此,仍需要进一步研究以全面了解其长期影响、评估成本效益,并准确确定哪些患者亚组可能从该治疗中获得最大益处。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3af1/11259422/d7b31a5a148a/10125AMEX243-ACM-94-366-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3af1/11259422/d7b31a5a148a/10125AMEX243-ACM-94-366-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3af1/11259422/d7b31a5a148a/10125AMEX243-ACM-94-366-g001.jpg

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1
[The current state of renal sympathetic denervation in hypertension].[高血压患者肾交感神经去神经支配的现状]
Arch Cardiol Mex. 2024 Feb 15;94(3):366-372. doi: 10.24875/ACM.23000191.
2
Modulation of Sympathetic Overactivity to Treat Resistant Hypertension.调节交感神经活性治疗难治性高血压。
Curr Hypertens Rep. 2018 Sep 7;20(11):92. doi: 10.1007/s11906-018-0893-8.
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Renal sympathetic denervation for treatment of hypertension: where are we now in 2019?肾去交感神经术治疗高血压:2019 年我们处于什么位置?
Curr Opin Nephrol Hypertens. 2019 Sep;28(5):498-506. doi: 10.1097/MNH.0000000000000532.
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The SPYRAL HTN Global Clinical Trial Program: Rationale and design for studies of renal denervation in the absence (SPYRAL HTN OFF-MED) and presence (SPYRAL HTN ON-MED) of antihypertensive medications.SPYRAL HTN全球临床试验项目:在未使用(SPYRAL HTN OFF-MED)和使用(SPYRAL HTN ON-MED)抗高血压药物的情况下进行肾去神经支配研究的原理与设计。
Am Heart J. 2016 Jan;171(1):82-91. doi: 10.1016/j.ahj.2015.08.021. Epub 2015 Sep 11.
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Am Heart J. 2018 Jan;195:115-129. doi: 10.1016/j.ahj.2017.09.006. Epub 2017 Sep 12.
6
[Renal denervation: current state and future perspectives].[肾去神经支配:现状与未来展望]
Herz. 2012 Nov;37(7):746-53. doi: 10.1007/s00059-012-3689-7.
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Rationale and design of two randomized sham-controlled trials of catheter-based renal denervation in subjects with uncontrolled hypertension in the absence (SPYRAL HTN-OFF MED Pivotal) and presence (SPYRAL HTN-ON MED Expansion) of antihypertensive medications: a novel approach using Bayesian design.无抗高血压药物时(SPYRAL HTN-OFF MED 关键)和存在抗高血压药物时(SPYRAL HTN-ON MED 扩展)基于导管的肾去神经支配在未控制高血压患者中的两项随机假对照试验的原理和设计:一种使用贝叶斯设计的新方法。
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Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 Trial.基于导管的肾脏去神经术治疗耐药性高血压:SYMPLICITY HTN-3 试验的原理和设计。
Clin Cardiol. 2012 Sep;35(9):528-35. doi: 10.1002/clc.22008. Epub 2012 May 9.
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Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial.基于导管的肾动脉去神经术治疗耐药性高血压的长期结果:随机 SYMPLICITY HTN-3 试验的最终随访。
Lancet. 2022 Oct 22;400(10361):1405-1416. doi: 10.1016/S0140-6736(22)01787-1. Epub 2022 Sep 18.
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Renal Denervation in the Management of Resistant Hypertension: A Comprehensive Review of Literature.肾动脉去神经术在难治性高血压治疗中的应用:文献综述。
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本文引用的文献

1
2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA).2023ESH 动脉高血压管理指南 欧洲高血压学会动脉高血压管理工作组:得到国际高血压学会 (ISH) 和欧洲肾脏协会 (ERA) 的认可。
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Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial.血管内超声肾脏去神经治疗高血压:RADIANCE II 随机临床试验。
JAMA. 2023 Feb 28;329(8):651-661. doi: 10.1001/jama.2023.0713.
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Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range.
根据治疗收缩压范围内的时间,肾去神经支配后心血管风险降低。
J Am Coll Cardiol. 2022 Nov 15;80(20):1871-1880. doi: 10.1016/j.jacc.2022.08.802.
4
Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial.基于导管的肾动脉去神经术治疗耐药性高血压的长期结果:随机 SYMPLICITY HTN-3 试验的最终随访。
Lancet. 2022 Oct 22;400(10361):1405-1416. doi: 10.1016/S0140-6736(22)01787-1. Epub 2022 Sep 18.
5
Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial.在使用抗高血压药物的情况下肾动脉去神经术的长期疗效和安全性(SPYRAL HTN-ON MED):一项随机、假手术对照试验。
Lancet. 2022 Apr 9;399(10333):1401-1410. doi: 10.1016/S0140-6736(22)00455-X. Epub 2022 Apr 4.
6
Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.全球高血压患病率趋势及 1990 至 2019 年治疗和控制进展情况:1040 万参与者、1201 项人群代表性研究的汇总分析
Lancet. 2021 Sep 11;398(10304):957-980. doi: 10.1016/S0140-6736(21)01330-1. Epub 2021 Aug 24.
7
Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial.超声肾动脉去神经术治疗三联药物治疗抵抗的高血压(RADIANCE-HTN TRIO):一项随机、多中心、单盲、假手术对照试验。
Lancet. 2021 Jun 26;397(10293):2476-2486. doi: 10.1016/S0140-6736(21)00788-1. Epub 2021 May 16.
8
Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial.在不使用抗高血压药物的情况下基于导管的肾脏去神经术的疗效(SPYRAL HTN-OFF MED Pivotal):一项多中心、随机、假对照试验。
Lancet. 2020 May 2;395(10234):1444-1451. doi: 10.1016/S0140-6736(20)30554-7. Epub 2020 Mar 29.
9
Review and meta-analysis of renal artery damage following percutaneous renal denervation with radiofrequency renal artery ablation.射频肾动脉消融经皮肾去神经术后肾动脉损伤的回顾性分析及荟萃分析。
EuroIntervention. 2020 May 20;16(1):89-96. doi: 10.4244/EIJ-D-19-00902.
10
Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the Global SYMPLICITY Registry.肾去神经术对肾功能和长期结局的影响:全球 SYMPLICITY 注册研究的 3 年随访结果。
Eur Heart J. 2019 Nov 1;40(42):3474-3482. doi: 10.1093/eurheartj/ehz118.