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去肾神经术治疗高血压临床研究回顾与最新进展

Renal denervation treatment for hypertension: review of clinical evidence and latest advances

  • 摘要: 基于临床证据,无论患者是否使用降压药物,经导管去肾神经术(RDN)已被证实能显著降低各种血压指标,包括诊室血压、家庭血压和24 h动态血压。多项大型随机假手术对照试验确认了RDN的安全性和有效性,在亚洲人群中尤其显现优异成效。目前,已有多项在中国人群中进行的假手术对照试验结果显示,中国人群24 h动态收缩压降低幅度(约-9 mmHg)优于西方国家试验。此外,中国长期随访研究显示,射频RDN使血压持续降低长达10年。评估RDN疗效的最佳指标依次为晨起家庭血压、夜间血压监测及晨起谷值诊室血压。考虑到亚洲血压特征、RDN长期疗效及其在控制24 h血压优势,RDN应被视为亚洲高血压患者的有效选择。目前,中国等多个亚洲国家及地区已批准RDN用于临床治疗,相应指南也已纳入RDN作为治疗选项。

     

    Abstract: Based on clinical evidence, catheter-based renal denervation (RDN) has been proven to significantly reduce various blood pressure measurements, including office blood pressure, home blood pressure, and 24-hour ambulatory blood pressure, regardless of whether patients are treated with antihypertensive medications. Multiple large randomized sham-controlled trials have confirmed the safety and efficacy of RDN, showing particularly excellent results in Asian populations. Several sham-controlled radiofrequency RDN trials conducted in Chinese populations have been published, showing that the reduction in 24-hour ambulatory systolic blood pressure in Chinese populations (approximately -9 mmHg) is superior to that observed in Western trials. Additionally, long-term follow-up studies in China have shown that radiofrequency RDN continues to reduce blood pressures for up to ten years. The best indicators for evaluating RDN efficacy are, in order: morning home blood pressure, nighttime (asleep) blood pressure monitoring, and morning trough office blood pressure. Considering Asian blood pressure characteristics, RDN’s long-term efficacy, and its advantages in 24-hour blood pressure control, RDN should be considered an effective option for Asian hypertensive patients. Currently, China and several other Asian countries and regions have approved RDN for clinical use, and corresponding guidelines have endorsed RDN as an effective treatment option for uncontrolled and resistant hypertension.

     

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