[意大利介入心脏病学学会(GISE)和意大利动脉高血压学会(SIIA)关于肾去神经支配在难以治疗的高血压管理中的作用的共识文件]。

IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Eugenio Stabile, Maria Lorenza Muiesan, Flavio Luciano Ribichini, Giuseppe Sangiorgi, Stefano Taddei, Francesco Versaci, Bruno Villari, Alessandra Bacca, Daniela Benedetto, Vincenzo Fioretti, Gaetano Liccardo, Eugenio Laurenzano, Massimiliano Scappaticci, Francesco Saia, Giuseppe Tarantini, Guido Grassi, Giovanni Esposito
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引用次数: 0

摘要

动脉性高血压是全世界最常见的心血管危险因素。尽管有许多有效的抗高血压药物,但血压失控(BP)的患病率仍然很高。长期以来,交感神经过度活跃一直被认为是抵抗性高血压的主要原因,基于导管的肾去神经支配(RDN)已成为一种降低血压的新策略。RDN旨在通过在血管周围空间施加射频(RF)能量、超声(US)能量或注射酒精来中断肾交感神经的活动。Symplicity HTN-3试验是使用第一代基于射频的RDN设备的最大的假对照试验,未能显著降低血压。从那时起,新的设备和技术已经被开发出来,因此许多使用第二代射频或基于美国的RDN设备的假对照试验已经证明了该程序的降压功效和安全性。一个由高血压专家、具有肾脏干预专业知识的干预医生和麻醉师组成的多学科团队,在选择手术候选人到术后护理方面发挥着关键作用。本共识文件的目的是总结目前关于RDN在难治性高血压中的使用的证据,并提出从选择手术候选患者到术后护理的管理策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Italian Society of Interventional Cardiology (GISE) and Italian Society of Arterial Hypertension (SIIA) Consensus document on the role of renal denervation in the management of the difficult to treat hypertension].

Arterial hypertension is the most prevalent cardiovascular risk factor worldwide. Despite the availability of many and effective antihypertensive medications, the prevalence of uncontrolled blood pressure (BP) remains high. As sympathetic hyperactivity has long been recognized as a major contributor to resistant hypertension, catheter-based renal denervation (RDN) has emerged as a new strategy to reduce BP. RDN aims to interrupt the activity of renal sympathetic nerves by applying radiofrequency (RF) energy, ultrasound (US) energy, or injection of alcohol in the perivascular space. The Symplicity HTN-3 trial, the largest sham-controlled trial using the first-generation RF-based RDN device, failed to significantly reduce BP. Since then, new devices and techniques have been developed and consequently many sham-controlled trials using second-generation RF or US-based RDN devices have demonstrated the BP lowering efficacy and safety of the procedure. A multidisciplinary team involving hypertension experts, interventionalists with expertise in renal interventions and anesthesiologists, plays a pivotal role from the selection of the patient candidate for the procedure to the post-procedural care. The aim of this consensus document is to summarize the current evidence about the use of RDN in difficult to treat hypertension and to propose a management strategy from the selection of the patient candidate for the procedure to the post-procedural care.

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Giornale italiano di cardiologia
Giornale italiano di cardiologia CARDIAC & CARDIOVASCULAR SYSTEMS-
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