Renal nerves: time for reassessment of their role in hypertension?
Renal nerves: time for reassessment of their role in hypertension?
复制标题
肾神经：是时候重新评估其在高血压中的作用了？
DOI：
10.1093/ajh/hpu096
复制
发表时间：
2014
影响因子：
3.2
通讯作者：
Osborn,JohnW
中科院分区：
文献类型：
--
作者：
Fink,GregoryD;Osborn,JohnW
基于导管的肾神经消融术(CBRNA)是一种有前景的降压新方法，可用于治疗难治性高血压患者。1该方法背后的概念源于几十年来在实验室动物中的工作，这些工作表明肾神经在实验性高血压中对血压调节的显著作用以及这种作用背后的生理机制。然而，CBRNA在人体试验中疗效的早期迹象导致了人们对该程序的兴趣激增，并迅速应用于世界各地的数千名患者。3大多数研究都适当地集中在该手术的临床有效性和安全性上。另一方面，对某些(但不是全部)患者血压持续下降的具体生理机制的识别相对较少。最近一份关于首个针对严重抵抗高血压患者的前瞻性、双盲、随机、假对照试验(Symplicity HTN-3)的报告4显示，CBRNA未能显著降低血压。该报告重新激发了人们对肾神经最有可能影响高血压患者血压的生理条件及其相关机制的考虑。这也带来了这样一个问题，即到底需要多少肾神经损伤才能对高血压患者的血压产生有意义的影响。本期《华尔街日报》发表了两篇文章，其中一篇由Henegar等人撰写。5和Linz等人的一篇，6报告了实验动物研究的数据，这些数据在这些问题上提供了重要的新线索。与之最直接相关的是Henegar等人的研究。5研究人员使用一种典型的犬高血压模型和专为人类设计的导管装置(St.Jude Medical EnigHTN System)来研究去神经对血压和其他相关生理变量的急性和慢性影响。值得一提的是书房设计的几个有价值的特点。首先，对患有慢性阻塞性肺疾病的狗进行肾去神经手术。
Catheter-based renal nerve ablation (CBRNA) is a promising new approach to reducing blood pressure in human patients with drug-resistant hypertension. 1 The concept behind the method was derived from many decades of work in laboratory animals that showed the significant effect of renal nerves on blood pressure regulation in experimental hypertension and the physiological mechanisms underlying that effect. 2 Early indications of efficacy of CBRNA in human trials, however, led to an explosion of interest in the procedure and its rapid application to thousands of patients worldwide. 3 Most studies have appropriately focused on the clinical efficacy and safety of the procedure. On the other hand, comparatively little attention has been paid to identifying the specific physiological mechanisms responsible for the persistent fall in blood pressure seen in some (but not all) patients.A highly publicized recent report 4 on the first prospective, double-blind, randomized, sham-controlled trial in patients with severe resistant hypertension (Symplicity HTN-3) showed that CBRNA failed to lower blood pressure significantly more than a sham procedure. The report has re-energized consideration of the physiological conditions under which the renal nerves are most likely to affect blood pressure in hypertension and the mechanisms responsible. It also has brought to the foreground questions about precisely how much renal nerve damage is necessary to meaningfully affect blood pressure in hypertensive subjects. Two articles appearing in this issue of the Journal, one by Henegar et al. 5 and one by Linz et al., 6 report data from experimental animal studies that shed significant new light on these issues. The most directly germane is the study by Henegar et al. 5 These investigators used a well-characterized dog model of hypertension and a catheter device designed for human applications (St. Jude Medical EnligHTN system) to investigate the acute and chronic effects of renal denervation on blood pressure and other relevant physiological variables. Several valuable features of the study design deserve mention. First, renal denervation was performed in dogs with