Orlando， Fl. – 在第58届ACC年会上提出了一项安全有效的研究，对于药物治疗高血压患者不理想的患者应用一种经导管引导下的肾交感神经射频消融技术可以达到稳定而持续的降压效果。

    肾交感神经过度兴奋对进展性高血压有重要影响。尽管很多血压过高的患者已经联合应用多种降压药治疗，却仍然不能达到目标血压值。对于这种患者来说，肾交感神经系统的作用可能是一个能控制血压病降低心血管病事件的重要因素，如减少心梗和中风的发生。目前这项实验研究的是收缩压至少在160mmHg以上并至少联合三种降压药治疗（其中一种是利尿剂）的患者应用导管引导下的去肾交感神经治疗的效果。

    来自澳大利亚莫纳什大学心血管病研究治疗中心的 Henry Krum教授说道：“这项技术与心内科冠状动脉经导管介入治疗的操作过程类似，导管经股动脉入路，当进入肾动脉时，术者发送射频波就可以切断肾交感神经并不会损害邻近血管。总共有5-6中射频信号可应用于手术过程中。”

    这项新技术已经对来自澳大利亚及欧洲的五个研究中心的45名患者进行过。他们的平均年龄是58±9岁，其中女性占44%，糖尿病患者占31%，并且有22%的人患有冠心病。这项研究原本入选了50名患者，但由于其中5人发现有解剖上异常而取消了这一研究。

    这些患者尽管平均服用5种降血压药物，但他们在办公室的平均基线血压值仍在177/101±20/15mmHg，平均估计肾小球滤过率为81 ± 23 mL/min/1.732，心率为72 ±11/min。

    在去除了肾交感神经后，在1个月、3个月、6个月、12个月时测得的办公室血压值分别下降了14/10， 21/10， 22/11及27/17 mmHg。估计肾小球滤过率和心率不变。

    另外5个未去除肾交感神经的患者，他们的收缩压在1个月和3个月内分别增加了1 mmHg及10 mmHg。

    Krum教授最后评论到，实施这项技术后至少需要12个月才能获得良好的稳定的效果。其中一个问题是，如果去势后的神经再生，那么我们得到的良好的降压效果就会消失吗？即使超过12个月，我们也无法回答这个问题。但至少在第12个月时，显著而持续的降压效果是肯定的。如果是的话，那么后续的研究将更令人期待。

（陈维君 吕树铮  首都医科大学附属北京安贞医院）

英文原文：
SIMPLE TECHNIQUE CAUSES SUBSTANTIAL BLOOD PRESSURE REDUCTION IN PATIENTS WITH RESISTANT HYPERTENSION
Catheter-Based Renal Denervation Lowers Blood Pressure in Patients Who Failed Multiple Anti-Hypertensive Medical Treatment

Orlando， Fl. – In a first-in-man safety and efficacy study， renal sympathetic nerve ablation with catheter-guided radiofrequency achieved a substantial and sustained reduction in blood pressure in patients whose hypertension defied optimal medical therapy， according to research presented today at the American College of Cardiology’s 58th annual scientific session.

Renal sympathetic hyperactivity is important in the progression of hypertension. For the many patients who cannot lower their high blood pressure down to acceptable levels despite use of multiple anti-hypertensive agents， manipulating the renal sympathetic system could be an important way to control blood pressure and help reduce their risk for major cardiovascular events， such as myocardial infarction and stroke. The present trial tested catheter-based renal denervation in patients whose systolic blood pressure was at least 160 mmHg on at least three antihypertensive drugs， one of which was a diuretic.

“This is a similar approach to that used for cardiac procedures via coronary artery catheterization，” said Henry Krum， MBBS， Ph.D， Director of the Centre of Cardiovascular Research & Education in Therapeutics at Monash University， Melbourne， Australia. “The catheter is inserted via the femoral artery， and when within the renal artery， the operator sends out radio waves which denervate the sympathetic nerves without damaging the lining of the vessel. In all， five or six radiofrequency signals are applied.”

The novel procedure was tested in 45 patients at five centers in Australia and Europe. The patients’ mean age was 58 ± 9 years， 44 percent were female， 31 percent were diabetic and 22 percent had coronary artery disease. The study enrolled 50 patients; however， five were disqualified from having the procedure because they were discovered to be anatomically unsuitable.

The mean baseline office blood pressure was 177/101 ± 20/15 mmHg despite a mean of five anti-hypertensive medications. The mean estimated glomerular filtration rate was 81 ± 23 mL/min/1.732 and heart rate was 72 + 11/min.
After the renal denervation， office blood pressures， which were measured at one， three， six and 12 months， were reduced by 14/10， 21/10， 22/11 and 27/17 mmHg， respectively. Estimated glomerular filtration rate and heart rate were unchanged.

Among the five untreated patients， mean rises in systolic blood pressure were one and 10 mmHg at one and three months， respectively.

“The critical thing was that， at least after 12 months， the benefits persisted，” Krum said. “One of the questions asked about the procedure is， will the nerves regrow， and as a result， the benefit starts to disappear over time? We can’t answer that question beyond 12 months， but at least at 12 months， the benefits persisted and indeed， if anything， seemed greater.”