Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
Hypertens Res. 2024 Oct;47(10):2665-2670. doi: 10.1038/s41440-024-01755-y. Epub 2024 Jun 14.
Accumulating evidence supports the efficacy of renal denervation (RDN) as an antihypertensive treatment. Additionally, several RDN clinical studies, including meta-analyses, have suggested that RDN may potentially have beneficial effects on left ventricular hypertrophy, diastolic function, and new-onset/recurrence of atrial fibrillation (AF), although most studies were not randomized sham-controlled. In particular, the effects of RDN on left ventricular hypertrophy and AF recurrence appear to be relatively evident. Sympathetic activation plays a critical role in the development of hypertension, hypertensive heart disease, and AF. Notably, several studies suggest the cardioprotective effects of RDN even in the absence of significant blood pressure reduction, probably due to its sympathoinhibitory effects. It is imperative to establish the efficacy of RDN in patients with hypertensive heart disease and/or AF, focusing on parameters of sympathetic activity in the clinical setting, including randomized sham-controlled trials. Moreover, further basic research is essential to elucidate the therapeutic mechanisms of RDN beyond blood pressure lowering and the renal nerves-linked pathophysiologies of hypertensive heart disease and AF. This review outlines the effects of renal denervation on hypertensive heart disease, particularly on left ventricular hypertrophy and diastolic function, and on atrial fibrillation. The sympathoinhibitory effect of renal denervation, an important potential mechanism of its beneficial effects on heart disease, is also discussed.
越来越多的证据支持肾去神经术（RDN）作为一种降压治疗的有效性。此外，几项 RDN 临床研究，包括荟萃分析，表明 RDN 可能对左心室肥厚、舒张功能和新发/复发性心房颤动（AF）有潜在的有益影响，尽管大多数研究不是随机假手术对照。特别是，RDN 对左心室肥厚和 AF 复发的影响似乎相对明显。交感神经激活在高血压、高血压性心脏病和 AF 的发展中起着关键作用。值得注意的是，几项研究表明 RDN 的心脏保护作用甚至在没有明显血压降低的情况下也存在，可能是由于其抑制交感神经的作用。在临床环境中，包括随机假手术对照试验，确定 RDN 在高血压性心脏病和/或 AF 患者中的疗效至关重要，重点关注交感神经活性的参数。此外，进一步的基础研究对于阐明 RDN 除降压和高血压性心脏病和 AF 相关的肾神经病理生理学以外的治疗机制是必要的。这篇综述概述了 RDN 对高血压性心脏病的影响，特别是对左心室肥厚和舒张功能以及心房颤动的影响。还讨论了 RDN 的抑制交感神经作用，这是其对心脏病有益影响的一个重要潜在机制。
