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Circulation：不同去肾神经方法治疗顽固性高血压

2018-09-26 荷塘月影 医学论坛网心血管

去肾神经顽固性高血压研究进展
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难治性高血压是指联合服用3种或以上合适剂量的抗高血压药物（其中一种为利尿剂），仍然无法控制的高血压。

难治性高血压是指联合服用3种或以上合适剂量的抗高血压药物（其中一种为利尿剂），仍然无法控制的高血压。肾交感神经活动是血压维持和升高的重要环节，肾交感神经的激活对高血压的发生及发展具有重要作用，其主要机制为影响肾脏血管收缩、增加肾素释放和加强水钠重吸收。肾交感神经射频消融术对难治性高血压患者具有肯定的降压效果。德国莱比锡大学心脏中心的Karl Fengler等人进行了一项头对头的比较研究（RADIOSOUND-HTN研究），观察不同的去肾神经技术对于顽固性高血压的疗效。研究者将顽固性高血压患者以1：1：1的比例随机分到：1）肾主动脉射频消融RDN，2）肾主动脉、侧支和附件的射频消融RDN，或3）基于血管内超声能源的RDN。主要终点是3个月白天动态收缩压（ABPM）的变化。该研究在2015年6月至2018年6月，共招募了120名患者（平均年龄64±9岁，白天平均血压153/86±12/13mmHg）。其中39例随机分到肾主动脉射频消融术，39例随机分到肾主动和侧支射频消融，42例随机分到超声RDN。各组之间的基线日间血压、临床特征和治疗方法均衡。在3个月时，整个队列患者的白天动态收缩压下降

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    2021-02-07 ms4000000125336763

    好

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=923440, encodeId=72729234404f, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=22945459306, createdName=ms4000000125336763, createdTime=Sun Feb 07 11:06:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1632882, encodeId=3eec1632882aa, content=<a href='/topic/show?id=5e1110013180' target=_blank style='color:#2F92EE;'>#顽固性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100131, encryptionId=5e1110013180, topicName=顽固性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5e4121955726, createdName=limedical1981, createdTime=Sat May 18 08:26:00 CST 2019, time=2019-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346846, encodeId=7d3e346846aa, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18741984753, createdName=smartxiuxiu, createdTime=Thu Sep 27 00:15:58 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346831, encodeId=e567346831c0, content=不错的文章值得拥有哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed Sep 26 22:22:17 CST 2018, time=2018-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346822, encodeId=1bfd34682246, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Wed Sep 26 21:12:38 CST 2018, time=2018-09-26, status=1, ipAttribution=)]
    2019-05-18 limedical1981

    #顽固性#

    0

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    2018-09-27 smartxiuxiu

    好

    0

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    2018-09-26 1e1b8538m79(暂无匿称)

    不错的文章值得拥有哦

    0

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    2018-09-26 医者仁心5538

    学习了

    0

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CIT 2014：SYMPLICITY HTN-3后时代，去肾神经治疗顽固性高血压路在何方？

顽固性高血压是一种特殊类型的高血压，在应用包括利尿剂在内的3种或以上的足量降压药血压仍难以达标或至少需4种降压药血压才能达标，可能导致严重的靶器官损伤和心血管风险，治疗十分棘手[1]。近年来国外已有前瞻性队列研究和随机对照研究表明[2-4]，经导管射频消融肾交感神经术（renal sympathetic denervation，RDN）对于部分顽固性高血压患者具有显著持久的降压作用，且很少发生

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