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2024 年在奥地利进行肾脏去交感神经术:奥地利高血压学会的建议:得到奥地利肾脏病学会和奥地利心脏病学会介入心脏病学工作组的认可。

Renal sympathetic denervation 2024 in Austria: recommendations from the Austrian Society of Hypertension : Endorsed by the Austrian Society of Nephrology and the Working Group of Interventional Cardiology of the Austrian Society of Cardiology.

机构信息

Third Medical Department for Cardiology and Intensive Care, Vienna Healthcare Group, Clinic Ottakring, Montleartstraße 36, Pavillon 29, 1160, Vienna, Austria.

Division of Cardiology, Medical University of Graz, Graz, Austria.

出版信息

Wien Klin Wochenschr. 2024 Sep;136(Suppl 14):559-569. doi: 10.1007/s00508-024-02440-3. Epub 2024 Sep 23.

DOI:10.1007/s00508-024-02440-3
PMID:39311980
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11420322/
Abstract

Renal sympathetic denervation (RDN) is an interventional supplement to medical treatment in patients with arterial hypertension. While the first sham-controlled trial, SYMPLICITY HTN‑3 was neutral, with improved procedural details, patient selection and follow-up, recent randomized sham-controlled trials of second-generation devices show a consistent blood pressure lowering effect of RDN, as compared to sham controls. These new data and the recent U.S. Food and Drug Administration (FDA) premarket approval of two RDN devices are the basis for the present recommendations update.This joint position paper from the Austrian Society of Hypertension, together with the Austrian Society of Nephrology and the Working Group of Interventional Cardiology from the Austrian Society of Cardiology includes an overview about the available evidence on RDN and gives specific recommendations for the work-up, patient selection, pretreatment, procedural management and follow-up in patients undergoing RDN in Austria. Specifically, RDN may be used in clinical routine care, together with lifestyle measures and antihypertensive drugs, in patients with resistant hypertension (i.e. uncontrolled blood pressure on 3 antihypertensive drugs) and in those with uncontrolled hypertension, after adequate work-up, if institutional, patient-related and procedural conditions are fulfilled.

摘要

肾脏去交感神经术(RDN)是一种针对动脉性高血压患者的医学治疗的介入性补充手段。尽管首例假手术对照试验 SYMPLICITY HTN-3 的结果为中性,但随着手术细节、患者选择和随访的改进,最近的第二代设备随机假手术对照试验显示 RDN 确实具有一致的降压效果,与假手术对照组相比。这些新数据以及美国食品和药物管理局(FDA)最近对两种 RDN 设备的上市前批准是本次推荐更新的基础。这份由奥地利高血压学会、奥地利肾脏病学会和奥地利心脏病学会介入心脏病学工作组共同撰写的联合立场文件,概述了关于 RDN 的现有证据,并为在奥地利进行 RDN 的患者提供了具体的检查、患者选择、预处理、手术管理和随访建议。具体而言,RDN 可以与生活方式措施和降压药物一起用于临床常规治疗,适用于难治性高血压(即 3 种降压药物控制不佳的血压)的患者,以及在充分检查后,如果符合机构、患者相关和手术条件,可用于血压控制不佳的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8528/11420322/045247dbff9a/508_2024_2440_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8528/11420322/045247dbff9a/508_2024_2440_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8528/11420322/045247dbff9a/508_2024_2440_Fig1_HTML.jpg

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本文引用的文献

1
SCAI Position Statement on Renal Denervation for Hypertension: Patient Selection, Operator Competence, Training and Techniques, and Organizational Recommendations.SCAI关于高血压肾去神经支配的立场声明:患者选择、术者能力、培训与技术以及组织建议
J Soc Cardiovasc Angiogr Interv. 2023 Aug 21;2(6Part A):101121. doi: 10.1016/j.jscai.2023.101121. eCollection 2023 Nov-Dec.
2
Safety and Efficacy of Renal Denervation in Patients Taking Antihypertensive Medications.抗高血压药物治疗患者的肾脏去神经术的安全性和疗效。
J Am Coll Cardiol. 2023 Nov 7;82(19):1809-1823. doi: 10.1016/j.jacc.2023.08.045.
3
Alcohol-mediated renal denervation in patients with hypertension in the absence of antihypertensive medications.
在未使用抗高血压药物的情况下,酒精介导的高血压患者的肾脏去神经支配。
EuroIntervention. 2023 Sep 18;19(7):602-611. doi: 10.4244/EIJ-D-23-00088.
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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。
J Hypertens. 2023 Dec 1;41(12):1874-2071. doi: 10.1097/HJH.0000000000003480. Epub 2023 Sep 26.
5
Outcomes Following Radiofrequency Renal Denervation According to Antihypertensive Medications: Subgroup Analysis of the Global SYMPLICITY Registry DEFINE.根据降压药物对射频肾动脉去神经术治疗后结果的影响:SYMPLICITY 全球注册研究 DEFINE 亚组分析。
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