Tolu-Akinnawo Oluwaremilekun, Ray David N, Awosanya Tiwalade, Nzerue Chike, Okafor Henry
Internal Medicine, Meharry Medical College, Nashville, USA.
Medicine, Meharry Medical College, Nashville, USA.
Cureus. 2024 Aug 6;16(8):e66304. doi: 10.7759/cureus.66304. eCollection 2024 Aug.
Hypertension is the most prevalent modifiable risk factor associated with cardiovascular mortality. The World Health Organization (WHO) estimates that hypertension directly or indirectly causes the death of at least nine million people globally every year. The number of people living with hypertension (blood pressure (BP) of ≥140 mmHg systolic or ≥90 mmHg diastolic or on medication) doubled between 1990 and 2019, from 650 million to 1.3 billion. Despite a plethora of antihypertensive drugs widely available, a sizable part of the antihypertensive population stays uncontrolled. The unmet need of controlling BP in this population may be addressed, in part, by developing new drugs and devices/procedures to treat hypertension and its comorbidities. Several device-based approaches have been introduced to lower BP, and most of these strategies aim to modulate autonomic nervous system activity. Importantly, when considering a device-based treatment, each patient's underlying pathophysiology is considered, and the procedural risks are weighed against the cardiovascular risk attributed to the elevated BP. In November 2023, the FDA approved two renal denervation (RDN) devices. This manuscript discusses current interventional devices and procedures recently approved (RDN) and others in the clinical testing stage for arterial hypertension intervention or management. As we list below, all others have shown promising results and are being evaluated on a larger clinical trial. The new device-based classes are as follows: catheter-based RDN, baroreflex amplification, arteriovenous (AV) malformation, carotid body (CB) ablation, pacemaker-based cardiac neuromodulation, electro-acupuncture, and deep brain stimulation. Baroreflex amplification uses peripheral neuromodulation, while AV malformation leverages AV anastomosis. CB ablation modulates chemoreceptors, and pacemaker-based neuromodulation adjusts atrioventricular intervals. Electro-acupuncture proves potential, and deep brain stimulation offers central nervous system intervention.
高血压是与心血管死亡率相关的最普遍的可改变风险因素。世界卫生组织（WHO）估计，高血压每年在全球直接或间接导致至少900万人死亡。1990年至2019年间，高血压患者（收缩压≥140 mmHg或舒张压≥90 mmHg或正在接受药物治疗）的数量翻了一番，从6.5亿增至13亿。尽管有大量抗高血压药物广泛供应，但相当一部分高血压患者的血压仍未得到控制。通过开发治疗高血压及其合并症的新药和设备/程序，可能部分满足这一人群控制血压的未满足需求。已经引入了几种基于设备的方法来降低血压，其中大多数策略旨在调节自主神经系统活动。重要的是，在考虑基于设备的治疗时，会考虑每个患者的潜在病理生理学，并权衡手术风险与高血压所致的心血管风险。2023年11月，美国食品药品监督管理局（FDA）批准了两种肾去神经支配（RDN）设备。本文讨论了最近批准的用于动脉高血压干预或管理的当前介入设备和程序（RDN）以及处于临床试验阶段的其他设备和程序。如下所列，所有其他方法都已显示出有前景的结果，并正在更大规模的临床试验中进行评估。新的基于设备的类别如下：基于导管的心肾去神经支配、压力反射增强、动静脉（AV）畸形、颈动脉体（CB）消融、基于起搏器的心脏神经调节、电针和深部脑刺激。压力反射增强使用外周神经调节，而动静脉畸形利用动静脉吻合。颈动脉体消融调节化学感受器，基于起搏器的神经调节调整房室间期。电针已证明有潜力，深部脑刺激提供中枢神经系统干预。
