<p class="ql-block"> ? ? 腎去交感神經(jīng)支配治療高血壓：最新臨床綜述</p><p class="ql-block">? ? ? ? ? 安德魯·夏普、娜奧米·費(fèi)舍爾</p><p class="ql-block">? ? ? ? ? 美國(guó)高血壓雜志? ?七月 23， 2025</p><p class="ql-block" style="text-align: justify;">? ? ? 高血壓是全球死亡的主要危險(xiǎn)因素，影響著二分之一的成年人。盡管有數(shù)十種廉價(jià)藥物和生活方式的改變可以有效降低血壓，但高血壓控制率仍然很低。</p><p class="ql-block" style="text-align: justify;">? ? ? 腎去神經(jīng)支配 （RDN） 是一種程序療法，適用于高血壓的輔助治療。在發(fā)表了一系列嚴(yán)格的二代隨機(jī)臨床試驗(yàn)，證明了該程序療法的安全性和有效性后。FDA也于2023年底隨后批準(zhǔn)了該療法。目前，兩種采用射頻（Spyral）和超聲波（Paradise）的導(dǎo)管已被批準(zhǔn)用于消融腎交感神經(jīng)。? ??</p> <p class="ql-block">? ? ?在假對(duì)照組臨床隨機(jī)試驗(yàn)中，RDN 降低了輕度至中度高血壓，和真正抵抗性高血壓患者以及服用和停用抗高血壓藥物的患者的血壓。在評(píng)估患者的RDN時(shí)，共同決策是一個(gè)關(guān)鍵因素，其中應(yīng)包括患者潛在的益處，并且少數(shù)人可能對(duì)治療沒(méi)有反應(yīng)。? ? ? ? ? 對(duì)治療的反應(yīng)程度是一個(gè)恒定的預(yù)測(cè)因子：基線收縮壓的幅度，這也是指南建議優(yōu)先考慮頑固性高血壓患者以及無(wú)法通過(guò)藥物有效控制血壓的患者的原因之一。在將患者轉(zhuǎn)診給訓(xùn)練有素的介入醫(yī)生之前，優(yōu)化藥物治療和依從性，并在診室外確認(rèn)未控制的高血壓非常重要。</p><p class="ql-block">? ? ? 如果有臨床指征，應(yīng)篩查患者是否有原發(fā)性醛固酮增多癥和其他繼發(fā)性高血壓原因，但睡眠呼吸暫停不是 RDN 的禁忌證。建議采用團(tuán)隊(duì)方法，由高血壓專家和介入醫(yī)生合作。來(lái)自全球注冊(cè)管理機(jī)構(gòu)的數(shù)據(jù)將增強(qiáng)我們的知識(shí)并指導(dǎo)未來(lái)的實(shí)施。????????</p><p class="ql-block" style="text-align: justify;">? ? ? ? ? ? ? ? ? ? ? ?美國(guó)高血壓雜志? 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>