[1]李昱熙 张震 余静 蒋雄京.去肾神经治疗高血压的临床前景和探索方向[J].心血管病学进展,2024,(10):865.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.001]
 LI YuxiZHANG ZhenYU JingJIANG Xiongjing.Future of Renal Denervation on Hypertension Therapy[J].Advances in Cardiovascular Diseases,2024,(10):865.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.001]
点击复制

去肾神经治疗高血压的临床前景和探索方向()
分享到:

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2024年10期
页码:
865
栏目:
约稿
出版日期:
2024-10-25

文章信息/Info

Title:
Future of Renal Denervation on Hypertension Therapy
作者:
李昱熙12 张震3 余静4 蒋雄京5
(1.北京大学第一医院心内科,北京 100034;2.北京大学第一医院信息中心,北京 100034;3.西南交通大学附属医院 成都市第三人民医院心内科 成都市心血管病研究所,四川 成都 610031;4.兰州大学第二医院心内科,甘肃 兰州 730030;5.中国医学科学院阜外医院,北京 100037)
Author(s):
LI Yuxi12ZHANG Zhen3YU Jing4JIANG Xiongjing5
(1.Department of Cardiology,Peking University First Hospital,Beijing 100034,China2.Information Center,Peking University First Hospital,Beijing 100034,China3.Department of Cardiology,The Affiliated Hospital of Southwest Jiaotong University,The Third People’s Hospital of Chengdu,Cardiovascular Disease Research Institute of Chengdu,Chengdu 610031,Sichuan,China4.Department of Cardiology,Lanzhou University Second Hospital,Lanzhou 730030,Gansu,China5.Department of Cardiology,Fuwai Hospital,Chinese Academy of medical sciences,Beijing 100037,China)
关键词:
高血压去肾神经术临床应用
Keywords:
HypertensionRenal denervationClinical application
DOI:
10.16806/j.cnki.issn.1004-3934.2024.10.001
摘要:
许多随机临床试验显示经皮去肾神经术(RDN)具有降压的安全性和有效性,但目前其降压幅度有限,个体对治疗应答率不够高,尚缺乏改善高血压患者预后的直接证据,对治疗反应性的预测和术后即刻疗效的判定等方面手段有限,这些问题对临床应用构成巨大挑战。不同RDN消融手段间疗效比较、介入入路选择、器械性能改进及临床成本效益等也需进一步澄清。现就RDN治疗高血压的临床应用前景及进一步探索方向进行探讨。
Abstract:
Previous randomized clinical trials have demonstrated the safety and efficacy of renal denervation (RDN) in treating hypertension. However, the extent of blood pressure reduction is currently limited, and the individual response rate to treatment is not high enough. There is a lack of direct evidence to improve the clinical outcome prognosis among hypertension patients. The prediction of treatment response and the determination of immediate postoperative efficacy are also limited, posing significant challenges in clinical application. The comparison of therapeutic effects between different RDN ablation methods, the choice of interventional access, the improvement of device performance, and the clarification of clinical cost-effectiveness also require further elucidation. This review will explore the prospects of clinical application of RDN in the treatment of hypertension and the direction for further exploration

参考文献/References:

[1] 胡盛寿,王增武. 《中国心血管健康与疾病报告2022》概述[J]. 中国心血管病研究,2023,21(7):577-600.
[2] Wang JG,Zhang W,Li Y,et al. Hypertension in China:epidemiology and treatment initiatives[J]. Nat Rev Cardiol,2023,20(8):531-545.
[3] Krum H,Schlaich M,Whitbourn R,et al. Catheter-based renal sympathetic denervation for resistant hypertension:a multicentre safety and proof-of-principle cohort study[J]. Lancet,2009,373(9671):1275-1281.
[4] Esler MD,Krum H,Sobotka PA,et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial):a randomised controlled trial[J]. Lancet,2010,376(9756):1903-1909.
[5] Bhatt DL,Kandzari DE,O’Neill WW,et al. A controlled trial of renal denervation for resistant hypertension[J]. N Engl J Med,2014,370(15):1393-1401.
[6] Kario K,Ogawa H,Okumura K,et al. SYMPLICITY HTN-Japan—First randomized controlled trial of catheter-based renal denervation in Asian patients—[J]. Circ J,2015,79(6):1222-1229.
[7] Azizi M,Sapoval M,Gosse P,et al. Optimum and stepped care standardised antihypertensive treatment with or without renal denervation for resistant hypertension (DENERHTN):a multicentre,open-label,randomised controlled trial[J]. Lancet,2015,385(9981):1957-1965.
[8] Desch S,Okon T,Heinemann D,et al. Randomized sham-controlled trial of renal sympathetic denervation in mild resistant hypertension[J]. Hypertension,2015,65(6):1202-1208.
[9] Mathiassen ON,Vase H,Bech JN,et al. Renal denervation in treatment-resistant essential hypertension. A randomized,SHAM-controlled,double-blinded 24-h blood pressure-based trial[J]. J Hypertens,2016,34(8):1639-1647.
[10] de Jager RL,de Beus E,Beeftink MM,et al. Impact of medication adherence on the effect of renal denervation:the SYMPATHY trial[J]. Hypertension,2017,69(4):678-684.
[11] Warchol-Celinska E,Prejbisz A,Kadziela J,et al. Renal denervation in resistant hypertension and obstructive sleep apnea:randomized proof-of-concept phase Ⅱtrial[J]. Hypertension,2018,72(2):381-390.
[12] Townsend RR,Mahfoud F,Kandzari DE,et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED):a randomised, sham-controlled,proof-of-concept trial[J]. Lancet,2017,390(10108):2160-2170.
[13] Kandzari DE,B?hm M,Mahfoud F,et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs:6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial[J]. Lancet,2018,391(10137):2346-2355.
[14] Mahfoud F,Kandzari DE,Kario K,et al. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED):a randomised,sham-controlled trial[J]. Lancet,2022,399(10333):1401-1410.
[15] Azizi M,Schmieder RE,Mahfoud F,et al. Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO):a multicentre,international,single-blind,randomised,sham-controlled trial[J]. Lancet,2018,391(10137):2335-2345.
[16] Wang J,Yin Y,Lu C,et al. Efficacy and safety of sympathetic mapping and ablation of renal nerves for the treatment of hypertension (SMART):6-month follow-up of a randomised,controlled trial[J]. EClinicalMedicine,2024,72:102626.
[17] 李月平,卢成志,蒋雄京,等. 经皮去肾神经术治疗高血压中国专家科学声明[J]. 中国介入心脏病学杂志,2023,31(12):881-893.
[18] Barbato E,Azizi M,Schmieder RE,et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)[J]. Eur Heart J,2023,44(15):1313-1330.
[19] Mancia G,Kreutz R,Brunstr?m M,et al. 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)[J]. J Hypertens,2023,41(12):1874-2071.
[20] Guber K,Kirtane AJ. Renal sympathetic denervation for hypertension[J]. Kidney Int Rep,2022,7(10):2129-2140.
[21] 蒋雄京,姜凯文,贾楠,等. 当前经导管去肾神经术治疗高血压技术面面观——临床研究结果与存在的问题[J]. 中国循环杂志,2023,38(10):999-1004.
[22] Mahfoud F,Mancia G,Schmieder RE,et al. Cardiovascular risk reduction after renal denervation according to time in therapeutic systolic blood pressure range[J]. J Am Coll Cardiol,2022,80(20):1871-1880.
[23] Kordalis A,Tsiachris D,Pietri P,et al. Regression of organ damage following renal denervation in resistant hypertension:a meta-analysis[J]. J Hypertens,2018,36(8):1614-1621.
[24] Wang L,Li C,Li Z,et al. Ten-year follow-up of very-high risk hypertensive patients undergoing renal sympathetic denervation[J]. J Hypertens,2024,42(5):801-808.
[25] Wang TD,Lee YH,Chang SS,et al. 2019 Consensus Statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on renal denervation for the management of arterial hypertension[J]. Acta Cardiol Sin,2019,35(3):199-230.
[26] Saxena M,Schmieder RE,Kirtane AJ,et al. Predictors of blood pressure response to ultrasound renal denervation in the RADIANCE-HTN SOLO study[J]. J Hum Hypertens,2022,36(7):629-639.
[27] Gosse P,Cremer A,Kirtane AJ,et al. Ambulatory blood pressure monitoring to predict response to renal denervation:a post hoc analysis of the RADIANCE-HTN SOLO study[J]. Hypertension,2021,77(2):529-536.
[28] Rohla M,Nahler A,Lambert T,et al. Predictors of response to renal denervation for resistant arterial hypertension:a single center experience[J]. J Hypertens,2016,34(1):123-129.
[29] Tsioufis C,Papademetriou V,Dimitriadis K,et al. Catheter-based renal sympathetic denervation exerts acute and chronic effects on renal hemodynamics in swine[J]. Int J Cardiol,2013,168(2):987-992.
[30] D?r O,Liebetrau C,M?llmann H,et al. Brain-derived neurotrophic factor as a marker for immediate assessment of the success of renal sympathetic denervation[J]. J Am Coll Cardiol,2015,65(11):1151-1153.
[31] de Jong MR,Adiyaman A,Gal P,et al. Renal nerve stimulation-induced blood pressure changes predict ambulatory blood pressure response after renal denervation[J]. Hypertension,2016,68(3):707-714.
[32] Honton B,Pathak A,Sauguet A,et al. First report of transradial renal denervation with the dedicated radiofrequency Iberis? catheter[J]. EuroIntervention,2014,9(12):1385-1388.
[33] Fengler K,Rommel KP,Blazek S,et al. A three-arm randomized trial of different renal denervation devices and techniques in patients with resistant hypertension (RADIOSOUND-HTN)[J]. Circulation,2019,139(5):590-600.
[34] Chowdhury EK,Reid CM,Zomer E,et al. Cost-effectiveness of renal denervation therapy for treatment-resistant hypertension:a best case scenario[J]. Am J Hypertens,2018,31(10):1156-1163.
[35] Sharp ASP,Cao KN,Esler MD,et al. Cost-effectiveness of catheter-based radiofrequency renal denervation for the treatment of uncontrolled hypertension:an analysis for the UK based on recent clinical evidence[J]. Eur Heart J Qual Care Clin Outcomes,2024:qcae001.
[36] Bermpeis K,Ohashi H,Bertolone DT,et al. First-in-man robotic-assisted renal?denervation[J]. JACC Case Rep,2022,4(23):101669.
[37] Kandzari DE,Mahfoud F,Weber MA,et al. Clinical trial design principles and outcomes definitions for device-based therapies for hypertension:a consensus document from the Hypertension Academic Research Consortium[J]. Circulation,2022,145(11):847-863.

相似文献/References:

[1]孙刚,黄冠华,综述.高血压合并心力衰竭的治疗策略[J].心血管病学进展,2016,(2):201.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.027]
 SUN Gang,HUANG Guanhua.Treatment Strategy of Hypertension with Heart Failure[J].Advances in Cardiovascular Diseases,2016,(10):201.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.027]
[2]范贵娟,综述,徐瑞,等.盐敏感性高血压的研究进展[J].心血管病学进展,2016,(4):364.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.010]
 FAN Guijuan,XU Rui.Research Progress of Salt Sensitive Hypertension[J].Advances in Cardiovascular Diseases,2016,(10):364.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.010]
[3]陈源源.钙通道阻滞剂在降压治疗中的应用[J].心血管病学进展,2015,(6):662.[doi:10.3969/j.issn.1004-3934.2015.06.002]
 CHEN Yuanyuan.Application of Calcium Channel Blockers in Hypertension Treatment[J].Advances in Cardiovascular Diseases,2015,(10):662.[doi:10.3969/j.issn.1004-3934.2015.06.002]
[4]张瑞 毛露 孙硕 Dirk Hermann 陈艾东.内皮素-1干预成为高血压治疗新靶点的展望[J].心血管病学进展,2019,(7):969.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.000]
 ZHANG Rui MAO LuSUN ShuoDIRK Hermann CHEN Aidong.The Prospect of Endothelin-1 Intervention as A New Target for the Treatment of Hypertension[J].Advances in Cardiovascular Diseases,2019,(10):969.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.000]
[5]张毅,柳志红.动态血压监测在高血压中的应用现状与问题[J].心血管病学进展,2019,(6):848.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.003]
 ZHANG Yi,LIU Zhihong.Current status and nsolved Pproblems of Ambulatory Blood Pressure Monitoring for the Management of Hypertension[J].Advances in Cardiovascular Diseases,2019,(10):848.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.003]
[6]黄秋瑾 胡蓉.高血压合并糖尿病患者血压控制率和控制目标的探讨[J].心血管病学进展,2019,(7):973.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.002]
 HUANG QiujinHU Rong.Discussion on Blood Pressure Control Rate and Control Target in Patients with Hypertension Complicated with Diabetes[J].Advances in Cardiovascular Diseases,2019,(10):973.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.002]
[7]张旭明 王曦.高血压对认知功能的影响[J].心血管病学进展,2019,(7):977.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.003]
 ZHANG Xuming,WANG Xi.The Relationship Between Hypertension and Cognitive Function[J].Advances in Cardiovascular Diseases,2019,(10):977.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.003]
[8]凌梦军 陈明凌梦军.阻塞性睡眠呼吸暂停低通气综合征与高血压关系的研究进展[J].心血管病学进展,2019,(5):722.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.015]
[9]李波 郭毅 田进文 邓珏琳.高血压合并2型糖尿病的治疗进展[J].心血管病学进展,2019,(9):1196.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.002]
 LI Bo,GUO Yi,TIAN Jinwen,et al.Therapy in Hypertensive Patients with Type 2 Diabetes Mellitus[J].Advances in Cardiovascular Diseases,2019,(10):1196.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.002]
[10]王继航 赵施皓 李开亮 田进文 李玉龙 付士辉 沈明志 邓珏琳.远程医疗在高血压病管理中的研究进展[J].心血管病学进展,2019,(9):1199.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.003]
 WANG Jihang,ZHAO Shihao,LI Kailiang,et al.Telemedicine in Hypertension Management[J].Advances in Cardiovascular Diseases,2019,(10):1199.[doi:10.16806/j.cnki.issn.1004-3934.2019.09.003]
[11]陈晓平,左祥浩,叶涛,等.当前经导管去肾神经术治疗高血压面临的挑战[J].心血管病学进展,2024,(10):870.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.002]
 CHEN Xiaoping,ZUO Xianghao,YE Tao,et al.Current Challenges of Transcatheter Renal Denervation in the Treatment of Hypertension[J].Advances in Cardiovascular Diseases,2024,(10):870.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.002]
[12]亢园园 罗淞元 许建忠 罗建方 卢成志.当前不同去肾神经术的特点和存在的问题[J].心血管病学进展,2024,(10):875.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.003]
 KANG yuanyuan,LUO Songyuan,XU Jianzhong,et al.The Mechanisms and Future Challenges of Different Renal Denervation Therapy[J].Advances in Cardiovascular Diseases,2024,(10):875.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.003]
[13]王沛坚 陈威 董徽 马为.中国自主研发RDN器械治疗高血压临床试验数据的特色[J].心血管病学进展,2024,(10):880.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.004]
 WANG Peijian,CHEN Wei,DONG Hui,et al.Characteristics of Clinical Trial Data of RDN Devices Independently Developed in China[J].Advances in Cardiovascular Diseases,2024,(10):880.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.004]
[14]封欣妤 张冬颖 邹玉宝 冯颖青 程康.如何选择去肾神经术治疗高血压的最适宜人群[J].心血管病学进展,2024,(10):885.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.005]
 FENG Xinyu,ZHANG Dongying,ZOU Yubao,et al.How to Select the Optimal Population for Renal Denervation in the Treatment of Hypertension[J].Advances in Cardiovascular Diseases,2024,(10):885.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.005]
[15]董一飞 张毅 李燕 贾楠.经皮去肾神经术治疗高血压的临床获益:证据和争议[J].心血管病学进展,2024,(10):890.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.006]
 DONG Yifei,ZHANG Yi,LI Yan,et al.Clinical Benefit of Renal Denervation In the Treatment of Hypertension:Evidence And Controversy[J].Advances in Cardiovascular Diseases,2024,(10):890.[doi:10.16806/j.cnki.issn.1004-3934.2024.10.006]

更新日期/Last Update: 2024-11-01