经皮射频消融去除肾交感神经治疗顽固性高血压的研究进展

原发性高血压（高血压）是全球主要的公共卫生问题之一,也是脑卒中、冠状动脉粥样硬化性心脏病（冠心病）、心力衰竭、血管疾病和慢性肾衰竭的主要危险因素。按照目前高血压的诊断标准：收缩压≥140mmHg（1mmHg=0．133kPa）或（和）舒张压≥90mmHg,我国高血压患病率一直处于增长态势,每5个成人中就有两个人患高血压：2002年发病人数高达1．6亿,目前全国高血压患者近两亿人。但我国在高血压知晓率、治疗率和控制率方面却远远落后于发达国家,而全国高血压患者中8％～15％为顽固性高血压,按照这个数据估计,我国有将近5000万顽固性高血压患者。目前顽固性高血压的治疗策略主要包括改变生活习惯,联合应用降压药物,保护靶器官,控制多重危险因素等,但在我国,血压能达到治疗指南要求的靶目标水平的患者仅占6．1％。顽固性高血压严重地影响了人类健康,给社会带来了极大的负担,因此,我们迫切需要寻求一种有效的治疗策略。本文将针对顽固性高血压的肾交感神经射频消融治疗研究作一综述。     

经皮肾交感神经射频消融术治疗高血压研究的进展

高血压是心脑血管及肾脏疾病的主要危险因素。经导管肾交感神经消融为高血压提供了一种全新的治疗方法,展现了有效的降压及去交感神经效果,在治疗高血压的同时得到额外的收获。     

经皮导管射频消融去肾脏交感神经术治疗顽固性高血压的研究进展

<正>高血压是一个全球范围内的公共健康问题,它是导致心血管疾病如猝死和心肌梗死的主要因素[1]。因此,合理、有效地控制血压是改善人群生存率和生活质量的重要措施。有研究显示,23%~30%的高血压患者治疗效果不佳,此类人群为心血管事件的高危群体[2-3]。在美国,顽固性高血压在成人中占8.9%,并且占所有经药物治疗的成人高血压的12.8%[4-5]。顽固性高血压有     

导管消融肾动脉去交感神经术治疗难治性高血压的研究进展

<正>导管消融肾动脉去交感神经术(catheter-based renal sympathetic denervation,RDN),是通过在肾动脉内膜行导管消融,损伤沿血管外膜走行的支配肾脏的交感神经纤维,阻滞其传出和传入产生治疗效应。一、相关背景目前,RDN主要用于治疗难治性高血压,其在改善胰岛素抵抗、治疗心力衰竭(心衰)等方面的益处也开始被认     

经导管肾交感神经消融治疗顽固性高血压的进展

<正>尽管治疗高血压的药物种类繁多,但在改善生活方式的基础上,目前仍有15%～20%的高血压患者虽然应用了足量且合理联合的3种降压药物[1],血压依旧在目标水平之上。对于这部分顽固性高血压患者[2],在除外测压方法不当、继发性高血压以及治疗合并疾病后,效果不理想者可再     

经皮导管肾交感神经消融治疗顽固性高血压临床研究进展

<正>2013年6月14日发布的ESH/ESC最新版的高血压治疗指南中〔1〕,首次提出了"推荐药物治疗无效可以考虑RDN",推荐级别:Ⅱb,证据水平:C,这充分说明了经皮导管肾交感神经消融术(RDN)的重要性,这项技术充满了无限的挑战及前景,需要不断研究及探索。1顽固性高血压定义及流行病学特点高血压是"全球死亡风险最高的疾病"〔2〕,欧洲约有30%⁴5%的人患有高血压〔3〕,预计到2025年全球将有     

肾脏交感神经消融术治疗顽固性高血压

高血压病是全球性的主要健康问题,因“高发病率、高致残率、高致死率”而引起关注。经过合理的生活方式调节及药物治疗,仍有部分患者血压难以控制。经导管肾脏交感神经消融术为顽固性高血压患者的治疗提供了新的选择。本文着重介绍肾脏交感神经消融术的理论基础、临床试验、有效性、安全性及应用前景。     

肾交感神经消融术治疗高血压的进展及问题

尽管目前已经有众多的降血压药物应用于高血压的治疗,但是高血压的控制仍不尽如人意。由于高血压的高患病率及靶器官的损害,其仍然是影响公众健康的重大问题。近年来出现了一种治疗高血压的新技术———肾交感神经消融术,已部分应用于临床,但仍有一些问题限制该技术的广泛推广。     

肾交感神经消融术治疗顽固性高血压的现状与未来

目前,经导管肾交感神经射频消融术（catheter．basedrenalsympatheticdenervation,RDN）在欧美国家已逐渐被认可用于治疗顽固性高血压。     

应用盐水灌注射频消融导管行经皮肾去交感神经术治疗难治性高血压

目的应用盐水灌注射频消融导管对难治『生高血压患者行经皮肾去交感神经术（RSD）,观察其有效性、安全性。方法对连续30例难治性高血压患者行经皮肾去交感神经射频消融术,观察术前和术后1、3、6个月时的诊室血压和心率变化,术前和术后6个月时的动态血压变化,血清肌酐和估算的肾小球滤过率变化,以及手术并发症发生情况。结果30例患者术前血压为（169．7±10．7／94．3±12．3）mmHg,心率为（75．3±8．3）次／分,术后1、3、6个月时血压分别下降了（15．0±3．8／11．7±4．0）、（21．1±2．9／13．0±4．3）和（25．3±3．4／15．1±4．3）mmHg（P〈0．0001）,心率则分别下降（2．7±1．9）次／分（P〉0．05）、（4．1±2．0）次／分（P〈0．05）和（5．1±2．1）次／分（P〈0．05）。术前动态血压（158．1±9．2／90．0±12．5）mmHg,术后6个月时（135．8±12．8／78．3±12．6）mmHg（P〈0．0001）,肌酐和估算的肾小球滤过率无显著变化（P〉0．05）,2例患者发生股动脉血肿。结论应用盐水灌注射频消融导管行RSD安全、有效。     

高血压与肾交感神经活性的关系再评价

<正>高血压是一种常见的慢性疾病,常并发多种疾病而严重影响患者的生活质量,且增加心血管疾病患者的死亡风险,顽固性高血压的治疗至今仍是一个难题[1]。我们就高血压与肾交感神经活性的关系及治疗新技术做一综述。1高血压与肾交感神经的关系交感神经过度兴奋常常导致血压上升,而高血压患者也往往合并交感神经活性增加,尤其是肾交感神经活性增加。     

Renal sympathetic denervation in therapy resistant hypertension - pathophysiological aspects and predictors for treatment success

Many forms of human hypertension are associated with an increased systemic sympathetic activity. Especially the renal sympathetic nervous system has been found to play a prominent role in this context. Therefore, catheter-interventional renal sympathetic denervation (RDN) has been established as a treatment for patients suffering from therapy resistant hypertension in the past decade. The initial enthusiasm for this treatment was markedly dampened by the results of the Symplicity-HTN-3 trial, although the transferability of the results into clinical practice to date appears to be questionable. In contrast to the extensive use of RDN in treating hypertensive patients within or without clinical trial settings over the past years, its effects on the complex pathophysiological mechanisms underlying therapy resistant hypertension are only partly understood and are part of ongoing research. Effects of RDN have been described on many levels in human trials: From altered systemic sympathetic activity across cardiac and metabolic alterations down to changes in renal function. Most of these changes could sustainably change long-term morbidity and mortality of the treated patients, even if blood pressure remains unchanged. Furthermore, a number of promising predictors for a successful treatment with RDN have been identified recently and further trials are ongoing. This will certainly help to improve the preselection of potential candidates for RDN and thereby optimize treatment outcomes. This review summarizes important pathophysiologic effects of renal denervation and illustrates the currently known predictors for therapy success.     

Catheter ablation for atrial fibrillation in a subset of patients with concomitant hypertension

AIM:To study patients with atrial fibrillation and hypertension who had successful catheter ablation for changes in blood pressure 1 year later.METHODS:A retrospective study was performed on patients who had catheter ablation for atrial fibrillation(AF) and hypertension(HTN) which included local autonomic ganglionated plexi denervation and pulmonary veins isolation.Of the records of 119 patients,followup data was found in order to determine the presence of sinus rhythm and data on systolic(SBP) and diastolic blood pressure at 2 wk,3 mo,6 mo and 1 year after the ablation procedure.Transthoracic echocardiograms were taken at the time of the catheter procedure to determine left atrial dimensions(LADs) and left ventricular size.RESULTS:There was no significant difference in the preablation mean blood pressures between the two groups(P = 0.08).After 1 year 33 of the 60 with AF and HTN were in sinus rhythm,of whom 12 had normal LADs,≤ 4 cm Group 1,and 21 had enlarged left atria(LADs 4 cm,Group 2).For Group 1,at 1 year of follow up,there was a significant difference in the SBP(119.2 ± 13 mm Hg) compared to pre-ablation(142.6 ± 13.7 mm Hg,P = 0.001).For Group 2,there was no significant difference in the SBP,pre-ablation(130.3 ± 17.5 mm Hg) and at 1 year of follow up(130.4 ± 13.4 mm Hg,P = 0.75).All patients were on similar anti-hypertensive medications.There was a trend for a greater left ventricular size in Group 2 compared to Group 1.CONCLUSION:We suggest that Group 1 had HTN due to sympathetic hyperactivity,neurogenic HTN;whereas HTN in Group 2 was based on arterial vasoconstriction.     

Renal sympathetic nervous system and the effects of denervation on renal arteries

Resistant hypertension is associated with chronic activation of the sympathetic nervous system resulting in various comorbidities. The prevalence of resistant hypertension is often under estimated due to various reasons. Activation of sympathetic nervous system at the renal-as well as systemic-level contributes to the increased level of catecholamines and resulting increase in the blood pressure. This increased activity was demonstrated by increased muscle sympathetic nerve activity and renal and total body noradrenaline spillover. Apart from the hypertension, it is hypothesized to be associated with insulin resistance, congestive heart failure and obstructive sleep apnea. Renal denervation is a novel procedure where the sympathetic afferent and efferent activity is reduced by various techniques and has been used successfully to treat drug-resistant hypertension improvement of various metabolic derangements.Renal denervation has the unique advantage of offering the denervation at the renal level, thus mitigating the systemic side effects. Renal denervation can be done by various techniques including radiofrequency ablation, ultrasound guided ablation and chemical ablation. Various trials evaluated the role of renal denervation in the management of resistant hypertension and have found promising results. More studies are underway to evaluate the role of renal denervation in patients presenting with resistant hypertension in different scenarios. Appropriate patient selection might be the key in determining the effectiveness of the procedure.     

Nerve sprouting induced by radiofrequency catheter ablation in dogs

OBJECTIVES: The purpose of this study was to test the hypothesis that radiofrequency (RF) catheter ablation results in cardiac nerve sprouting. BACKGROUND: Nerve sprouting plays a role in cardiac arrhythmogenesis. Whether or not nerve sprouting occurs after RF catheter ablation is unclear. METHODS: We performed RF catheter ablation in the right atrium (RA) and right ventricle (RV) in 10 dogs, which then were sacrificed in 2 hours (acute group, n = 5) or 1 month (chronic group, n = 5). Seven normal dogs were used as control. Immunohistochemical staining for growth-associated protein 43 (GAP-43) was performed to measure growing (sprouting) nerves. RESULTS: A significant increase of GAP-43 immunoreactive nerve fiber density was observed at the RA ablation sites in 2 hours (4,410 +/- 1,379 microm(2)/mm(2)) and in 1 month (2,948 +/- 666 microm(2)/mm(2)) after ablation compared to controls (1,377 +/- 471 microm(2)/mm(2), P = .0001). At remote sites (>2 cm away from ablation sites) of RA, RF ablation also resulted in robust nerve sprouting in both the acute group (5,846 +/- 3241 microm(2)/mm(2)) and the chronic group (6,030 +/- 2226 microm(2)/mm(2)). RF ablation in the RV did not increase nerve density at the ablation sites, but nerve density was increased at remote sites in 2 hours (1,345 +/- 451 microm(2)/mm(2), P = .0136) that was reduced down to the normal control level (722 +/- 337 microm(2)/mm(2)) in 1 month. CONCLUSIONS: Nerve sprouting occurred within 2 hours after RF ablation in both the RA and RV and persisted for at least 1 month in the RA but not the RV. The increased GAP-43(+) nerve densities developed at both the ablation and the remote sites.