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难治性高血压的发生会显著增加患者发生心血管事件的风险。交感神经在高血压的发病机制中至关重要,目前药物以外的治疗方法越来越得到重视,其中肾动脉去神经术(RDN)逐渐显示出治疗难治性高血压的潜力,RDN分为射频消融、超声系统、化学技术3个方法。目前RDN研究的热点主要集中于经皮导管肾脏交感神经射频消融术。前期的非随机Symplicity HTN-1实验以及随机非盲法Symplicity HTN-2实验显示出了明显的降压效果。尽管后期严格设计、随机、假手术对照的Symplicity HTN-3研究未能达到主要疗效终点,但这种药物以外的治疗方法值得进一步探讨,现以RDN为核心话题作一综述。
Refractory hypertension can significantly increase the risk of developing cardiovascular events. Sympathetic nerves are crucial in the pathogenesis of hypertension. At present, more and more attention has been paid to treatments other than drugs. Among them, denervation of the renal artery (RDN) gradually shows the potential of treating refractory hypertension. RDN is divided into radio frequency Ablation, ultrasound system, chemical technology 3 ways. At present, RDN research focuses on percutaneous catheter renal sympathetic nerve radiofrequency ablation. Previous non-random Symplicity HTN-1 experiments and randomized, non-blinded Symplicity HTN-2 experiments showed significant antihypertensive effects. Although the late design, randomized, sham-operated Symplicity HTN-3 study failed to achieve the primary efficacy endpoint, treatment beyond this drug is worth further exploration and is now reviewed with RDN as the core topic.