- 期刊
頑固性高血壓之腎動脈交感神經阻斷術：回顧與新知
Renal Denervation in Resistant Hypertension
摘要
有效的高血壓治療可降低心臟血管及腎臟不良事件的風險，但部份病人雖然使用包括利尿劑在內的三種以上高血壓藥物治療且達最大可忍受劑量，仍未能達到血壓治療標的，即所謂頑固性高血壓（Resistant hypertension）患者。針對這類病人，目前標準治療方式包括重新臨床評估、積極改善生活習慣及藥物調整。腎動脈交感神經阻斷術（Renal artery sympatheticnerve denervation, RDN），初步證實能安全有效地控制血壓，國內衛生福利部於去年（2013年）初也已核准施行，今年三月底Bhatt DL, et al.於新英格蘭醫學雜誌期刊（The New EnglandJournal of Medicine）刊載指標性隨機單盲對照研究SYMPLICITY HTN-3，顯示阻斷術組比對照組在六個月時收縮壓並未如預期地大幅下降，此研究結果使我們更須謹慎檢視與深思RDN的臨床應用。隨著更多相關臨床經驗及研究文獻的發表，本組認為醫師對此項高血壓治療方法應有基本認識與重新檢視，於是本組回顧檢視相關文獻資料，系統性整理本文以供參考。期望更多醫師同好透過本文了解這項技術與相關研究。
並列摘要
Effective hypertension treatment decreases cardiovascular and renal events. However, a proportion of hypertensive patients who have been treated with three or more kinds of antihypertensive drugs containing diuretic regimen at maximally tolerated doses do not reach the goal of blood pressure control. They are so-called patients with resistant hypertension. For the patients, the standard management contains clinical reevaluation, aggressive lifestyle modification and adjustment of antihypertensive drugs. Renal artery sympathetic nerve denervation (RDN) considered as a new treatment strategy has been reported for safely and effectively controlling blood pressure. The technique was domestically permitted in early 2013. Bhatt DL, et al. reported the results of SYMPLICITY HTN-3, a randomized single-blinded controlled trial in the New England Journal of Medicine this March. The results revealed unpredicted similarity in systolic blood pressure between the RDN group and sham-procedure control group. This brings us to cautiously think over critical issues regarding clinical application of RDN. As the experience and evidence are increasingly documented, physicians need to update the knowledge with respect to the new modality for treating patients with resistant hypertension. Therefore, our team integrates the data and presents the review article here to show the essential studies related to the procedure. The article is expected to be helpful for readers to understand RDN and the related studies.
延伸閱讀
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- Hsiang, C. H. (2017). 動靜脈廔管及腎絲球腎炎之治療策略探討 [doctoral dissertation, National Taiwan Normal University]. Airiti Library. https://doi.org/10.6345/NTNU202203460
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- Abideen, Z. U. (2015). Tackling Resistant Hypertension - Is There a Role for Renal Denervation Therapy?. Journal of pioneering medical sciences, 5(1), 19-20. https://www.airitilibrary.com/Article/Detail?DocID=P20160812001-201503-201608120200-201608120200-19-20
- Papademetriou, V., Doumas, M., & Tsioufis, K. (2011). Renal Sympathetic Denervation for the Treatment of Difficult-to-Control or Resistant Hypertension. International Journal of Hypertension, 2011(), 212-219. https://doi.org/10.4061/2011/196518