Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Hypertens Res. 2024 Oct;47(10):2700-2710. doi: 10.1038/s41440-024-01858-6. Epub 2024 Aug 29.
Renal denervation (RDN) is a neuromodulation therapy performed in patients with hypertension using an intraarterial catheter. Recent randomized sham-controlled trials have shown that RDN has significant antihypertensive effects that last for more than 3 years. Based on this evidence, the US Food and Drug Administration has approved two devices, the ultrasound-based ReCor Paradise RDN system and the radiofrequency-based Medtronic Symplicity Spyral RDN system, as adjunctive therapy for patients with refractory and uncontrolled hypertension. On the other hand, there have been no randomized sham-controlled prospective outcome trials on RDN, and the effects of RDN on cardiovascular events such as myocardial infarction, heart failure, and stroke have not been elucidated. This mini-review summarizes the latest findings focusing on the effects of RDN on organ protection and physiological function and symptoms in both preclinical and clinical studies. Furthermore, the feasibility of using blood pressure as surrogate marker for cardiovascular outcomes is discussed in the context of relevant clinical studies on RDN. A comprehensive understanding of the beneficial effects of RDN on the incidence and severity of cardiovascular diseases with their underlying mechanisms will enhance physicians' ability to incorporate RDN into clinical strategies to prevent cardiovascular events including myocardial infarction, heart failure, and stroke. This mini-review focuses on the effects of RDN on organ protection and physiological function and symptoms in preclinical and clinical studies. RDN is expected to reduce the onset and progression of cardiovascular diseases including myocardial infarction, heart failure, and stroke in clinical practice. LV left ventricular, LVEF left ventricular ejection fraction, VO2max maximal oxygen uptake, VT ventricular tachycardia, VF ventricular fibrillation, 6MWD 6-min walk distance, NT-proBNP N-terminal pro-B-type natriuretic peptide, NYHA New York Heart Association, BBB blood-brain barrier, BP blood pressure.
肾脏去神经支配(RDN)是一种使用动脉内导管在高血压患者中进行的神经调节治疗。最近的随机假对照试验表明,RDN 具有显著的降压作用,持续时间超过 3 年。基于这一证据,美国食品和药物管理局已批准两种设备,即基于超声的 ReCor Paradise RDN 系统和基于射频的 Medtronic Symplicity Spyral RDN 系统,作为难治性和不受控制的高血压患者的辅助治疗。另一方面,RDN 尚未进行随机假对照前瞻性结局试验,RDN 对心肌梗死、心力衰竭和中风等心血管事件的影响也尚未阐明。这篇小型综述总结了最新的研究结果,重点关注 RDN 在临床前和临床研究中对器官保护和生理功能及症状的影响。此外,还讨论了在与 RDN 相关的临床研究中,使用血压作为心血管结局替代标志物的可行性。全面了解 RDN 对心血管疾病发病率和严重程度的有益影响及其潜在机制,将增强医生将 RDN 纳入预防包括心肌梗死、心力衰竭和中风在内的心血管事件的临床策略的能力。这篇小型综述重点关注 RDN 在临床前和临床研究中对器官保护和生理功能及症状的影响。RDN 有望减少包括心肌梗死、心力衰竭和中风在内的心血管疾病在临床实践中的发生和进展。LV 左心室,LVEF 左心室射血分数,VO2max 最大摄氧量,VT 室性心动过速,VF 心室颤动,6MWD 6 分钟步行距离,NT-proBNP N 末端 pro-B 型利钠肽,NYHA 纽约心脏协会,BBB 血脑屏障,BP 血压。