肾动脉狭窄的药物治疗:有效和适当吗?

Andrew B Covit
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引用次数: 9

摘要

血管内技术的最新进展从根本上改变了肾血管疾病患者临床治疗的选择。这些治疗方案引发了关于肾动脉狭窄的介入血管内治疗与保守治疗的适当性的持续争论。本综述研究了一个典型的临床病例,分析了相关的已发表文献和高血压预防、检测、评估和治疗全国联合委员会第七次报告(JNC 7)的最新指南,强调了在管理这一复杂患者群体时循证数据的重大缺陷。早期诊断为适当使用治疗方案和合理部署介入技术提供了最佳机会。保守医疗管理的建议是基于对已发表的介入系列的医疗管理章节的回顾。此外,对JNC 7高血压管理方案的实际修改提出了建议,以更好地解决肾血管性患者提出的具有挑战性的诊断和管理问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medical treatment of renal artery stenosis: is it effective and appropriate?

Recent advances in endovascular technology have radically changed the options available for the clinical management of the patient with renovascular disease. These treatment options have fueled an ongoing debate concerning the appropriateness of interventional endovascular therapy for the stenotic renal artery versus conservative medical management. This review examines a typical clinical case scenario and analyzes relevant published literature and the recent guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) highlighting the significant shortcomings of evidence-based data when it comes to the management of this complex patient population. Early diagnosis provides the best opportunity for appropriate utilization of therapeutic options and rational timing of deployment of interventional techniques. Recommendations for conservative medical management are made based on the review of the medical management arms of the published interventional series. In addition, suggestions are made for practical modifications to the JNC 7 hypertension management protocol to better address the challenging diagnostic and management issues raised by the renovascular patient.

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