Borghi Claudio, Bragagni Alessio
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Eur Heart J Suppl. 2025 Apr 16;27(Suppl 3):iii32-iii35. doi: 10.1093/eurheartjsupp/suaf012. eCollection 2025 Mar.
Systemic arterial hypertension is one of the leading causes of mortality and morbidity worldwide. Despite therapeutic advancements, a significant proportion of hypertensive patients fail to achieve adequate blood pressure control. Renal denervation (RDN) is emerging as an innovative and minimally invasive procedure to treat hypertension by modulating the renal sympathetic nervous system. Recent clinical trials, including SYMPLICITY HTN-3, SPYRAL HTN-OFF MED, and RADIANCE-HTN SOLO, have shown variable results, influenced by patient selection and study design. The latest 2024 ESC guidelines on systemic arterial hypertension recommend RDN as a therapeutic option in selected cases, especially in patients with resistant hypertension not adequately controlled by pharmacological therapy. However, the response to this approach varies according to individual pathophysiology and the level of sympathetic activation. This article highlights how RDN, performed using ultrasound or radiofrequency technologies, may represent a breakthrough for difficult-to-treat patients, bridging current therapeutic gaps and reducing long-term cardiovascular risk. Finally, it emphasizes the importance of a multi-disciplinary assessment to maximize the benefits of the procedure.
全身性动脉高血压是全球死亡和发病的主要原因之一。尽管治疗取得了进展，但仍有相当一部分高血压患者未能实现充分的血压控制。肾去神经支配术（RDN）作为一种通过调节肾交感神经系统来治疗高血压的创新型微创治疗方法正在兴起。包括SYMPLICITY HTN-3、SPYRAL HTN-OFF MED和RADIANCE-HTN SOLO在内的近期临床试验结果各异，这受到患者选择和研究设计的影响。最新的2024年欧洲心脏病学会（ESC）全身性动脉高血压指南推荐在特定情况下将RDN作为一种治疗选择，特别是在那些经药物治疗血压控制不佳的顽固性高血压患者中。然而，这种治疗方法的反应因个体病理生理学和交感神经激活水平而异。本文重点介绍了使用超声或射频技术进行的RDN如何可能为难治性患者带来突破，弥合当前的治疗差距并降低长期心血管风险。最后，强调了多学科评估对于最大化该治疗方法益处的重要性。
