肾去神经支配治疗顽固性高血压

IF 1.5 Q3 PERIPHERAL VASCULAR DISEASE Integrated Blood Pressure Control Pub Date : 2015-12-03 DOI:10.2147/IBPC.S65632
H. Patel, C. Hayward, V. Vassiliou, Ketna S Patel, J. Howard, C. Di Mario
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引用次数: 14

摘要

肾交感神经去支配作为一种治疗顽固性高血压的方法引起了人们的广泛关注。这一领域的大多数研究表明,它能显著降低血压(BP)。然而,这些试验不是随机的或假对照的,因此,由于试验偏差,研究结果可能被夸大了。HTN-3是第一个使用盲法假对照和动态血压监测的随机对照试验。令许多人惊讶的是,这项研究是中立的。这种中立性的可能原因包括:RSD可能对男性降压无效,由于操作者经验有限,RSD没有得到充分的执行,患者对抗高血压药物的依从性可能在试验期间发生了变化,可能干预只对某些尚未确定的亚组有效。未来旨在证明RSD疗效的研究应设计为随机盲法假对照试验。RSD的有效性尚存疑问,但许多人认为,通过对数千名患者实施该手术,其安全性已经得到了证实。然而,超过90%的这些数据是针对Symplicity™系统的,很少超过12个月的随访。不能假设RSD是长期安全的,也不应该假设如果一个导管系统是安全的,那么所有的都是安全的。我们希望在不久的将来,通过精心设计的临床试验,肾去神经支配在高血压治疗中的作用将被确立。
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Renal denervation for the management of resistant hypertension
Renal sympathetic denervation (RSD) as a therapy for patients with resistant hypertension has attracted great interest. The majority of studies in this field have demonstrated impressive reductions in blood pressure (BP). However, these trials were not randomized or sham-controlled and hence, the findings may have been overinflated due to trial biases. SYMPLICITY HTN-3 was the first randomized controlled trial to use a blinded sham-control and ambulatory BP monitoring. A surprise to many was that this study was neutral. Possible reasons for this neutrality include the fact that RSD may not be effective at lowering BP in man, RSD was not performed adequately due to limited operator experience, patients’ adherence with their anti-hypertensive drugs may have changed during the trial period, and perhaps the intervention only works in certain subgroups that are yet to be identified. Future studies seeking to demonstrate efficacy of RSD should be designed as randomized blinded sham-controlled trials. The efficacy of RSD is in doubt, but many feel that its safety has been established through the thousands of patients in whom the procedure has been performed. Over 90% of these data, however, are for the Symplicity™ system and rarely extend beyond 12 months of follow-up. Long-term safety cannot be assumed with RSD and nor should it be assumed that if one catheter system is safe then all are. We hope that in the near future, with the benefit of well-designed clinical trials, the role of renal denervation in the management of hypertension will be established.
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来源期刊
Integrated Blood Pressure Control
Integrated Blood Pressure Control PERIPHERAL VASCULAR DISEASE-
CiteScore
4.60
自引率
0.00%
发文量
13
审稿时长
16 weeks
期刊最新文献
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