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