<p class="ql-block"> 肾去交感神经支配治疗高血压：最新临床综述</p><p class="ql-block"> 安德鲁·夏普、娜奥米·费舍尔</p><p class="ql-block"> 美国高血压杂志 七月 23， 2025</p><p class="ql-block" style="text-align: justify;"> 高血压是全球死亡的主要危险因素，影响着二分之一的成年人。尽管有数十种廉价药物和生活方式的改变可以有效降低血压，但高血压控制率仍然很低。</p><p class="ql-block" style="text-align: justify;"> 肾去神经支配 （RDN） 是一种程序疗法，适用于高血压的辅助治疗。在发表了一系列严格的二代随机临床试验，证明了该程序疗法的安全性和有效性后。FDA也于2023年底随后批准了该疗法。目前，两种采用射频（Spyral）和超声波（Paradise）的导管已被批准用于消融肾交感神经。 </p> <p class="ql-block"> 在假对照组临床随机试验中，RDN 降低了轻度至中度高血压，和真正抵抗性高血压患者以及服用和停用抗高血压药物的患者的血压。在评估患者的RDN时，共同决策是一个关键因素，其中应包括患者潜在的益处，并且少数人可能对治疗没有反应。 对治疗的反应程度是一个恒定的预测因子：基线收缩压的幅度，这也是指南建议优先考虑顽固性高血压患者以及无法通过药物有效控制血压的患者的原因之一。在将患者转诊给训练有素的介入医生之前，优化药物治疗和依从性，并在诊室外确认未控制的高血压非常重要。</p><p class="ql-block"> 如果有临床指征，应筛查患者是否有原发性醛固酮增多症和其他继发性高血压原因，但睡眠呼吸暂停不是 RDN 的禁忌证。建议采用团队方法，由高血压专家和介入医生合作。来自全球注册管理机构的数据将增强我们的知识并指导未来的实施。 </p><p class="ql-block" style="text-align: justify;"> 美国高血压杂志 07， 23，2025</p> <p class="ql-block"> American Journal of Hypertension</p><p class="ql-block"> Journal • July 23, 2025</p><p class="ql-block"> Renal Denervation to Treat Hypertension: </p><p class="ql-block"> A Clinical State-of-the-Art Review.</p><p class="ql-block"> Andrew Sharp, Naomi Fisher</p><p class="ql-block"> Hypertension represents the leading risk factor for death globally, affecting one in two adults. Despite dozens of inexpensive medications and lifestyle changes that effectively lower blood pressure, hypertension control rates remain poor. Renal denervation (RDN) is a procedural therapy indicated as an adjunctive treatment for high blood pressure.</p><p class="ql-block"> FDA approval in late 2023 followed the publication of a series of rigorous, second-generation, randomized clinical trials that demonstrated safety and efficacy of the procedure. Two catheters employing radiofrequency (Spyral) and ultrasound (Paradise) are currently approved to ablate renal sympathetic nerves. In randomized sham-controlled trials, RDN lowered blood pressure in patients with mild-to-moderate and true resistant hypertension, and in patients both on and off anti-hypertensive medication. </p><p class="ql-block"> When evaluating patients for RDN, shared decision-making is a critical element, which should include potential benefits and that a minority may not respond to the therapy. There is only one constant predictor of magnitude of response: magnitude of baseline SBP, which is one reason why guidelines recommend prioritization of patients with resistant hypertension, together with patients whose BP cannot be effectively managed with medication.</p><p class="ql-block"> Before referring patients to a trained interventionalist, it is important to optimize medical therapy and adherence, and confirm uncontrolled hypertension out-of-office. Patients should be screened for primary aldosteronism and for other secondary causes of hypertension if clinically indicated, though sleep apnea is not a contraindication to RDN.</p><p class="ql-block"> A team approach is advised, with hypertension specialists and interventionalists collaborating. Data from global registries will augment our knowledge and guide future implementation.</p><p class="ql-block"> HypertensionCardiology</p><p class="ql-block"><br></p><p class="ql-block" style="text-align: justify;"> Read the Full Article</p>