難治性高血壓是心臟病和中風(fēng)的主要風(fēng)險(xiǎn)因素，根據(jù)一項(xiàng)刊登在美國心臟協(xié)會期刊的新研究表明，在不采取藥物治療的情況下，對腎臟周圍神經(jīng)持續(xù)發(fā)射短脈沖6個(gè)月至一年能有效控制血壓，這項(xiàng)研究對難治性高血壓的治療具有深遠(yuǎn)的公共健康學(xué)影響。

　　血壓高于140/90mm Hg被稱為高血壓，美國有78萬成年患者受高血壓影響。在美國高血壓成年患者中，約9%患有難治性高血壓，這表示他們需要服用4種以上藥物來控制血壓，或者說，當(dāng)他們服用3種不同的降壓藥后血壓仍然高于140/90mm Hg.研究將很快確定這種方法是否能夠治愈輕度高血壓，使患者在永久停藥的情況下保持正常血壓。一旦達(dá)到血壓正常值，心臟病和中風(fēng)的風(fēng)險(xiǎn)預(yù)計(jì)將減少40%以上?；趯?dǎo)管的腎臟去神經(jīng)支配療法是一種微創(chuàng)的治療方法。醫(yī)生將導(dǎo)管經(jīng)股動脈插入腹股溝，發(fā)射無線電波燒毀腎動脈周圍的神經(jīng)組織。

　　該實(shí)驗(yàn)結(jié)果來自于一項(xiàng)持續(xù)多中心國際研究Symplicity HTN-2，以評估腎臟去神經(jīng)支配法對高血壓的療效。這項(xiàng)研究基于2010年的一個(gè)發(fā)現(xiàn)，該發(fā)現(xiàn)顯示對腎臟動脈周圍神經(jīng)發(fā)射無線電波6個(gè)月后，耐藥高血壓患者血壓降低。

　　對照組參與者之前未接受此項(xiàng)治療，基于接受治療的患者出現(xiàn)積極反應(yīng)，對照組患者接受腎臟去神經(jīng)支配法。研究者選取35例對照組患者接受治療并與47例之前接受過治療的患者進(jìn)行對比。參與者血壓達(dá)到160mmHg或更高，服用3種以上抗高血壓藥，一些伴有糖尿病等其他疾病。研究者對參與者腎動脈進(jìn)形成像來顯示血壓變化過程。

　　研究者發(fā)現(xiàn)超過83%第一批接受腎臟去神經(jīng)支配療法的患者6個(gè)月內(nèi)收縮壓降低至少10mmHg，約79%12個(gè)月內(nèi)保持這種情況。后來接受治療的對照組效果類似，約63%降低10mmHg并維持至少6個(gè)月。參與治療的患者腎臟未由于功能受損遭到破壞，并未產(chǎn)生長期的副作用。

　　Radio Waves To Kidneys Lower Persistent High Blood Pressure

　　Main Category: Hypertension

　　Also Included In: Urology / Nephrology

　　Article Date: 24 Dec 2012 - 0:00 PST

　　Directing short bursts of radio waves at nerves surrounding the kidneys lowered blood pressure for at least six months and up to one year among patients with hypertension that persists regardless of taking multiple medications to control it, according to a new study published in the American Heart Association journal, Circulation.

　　The findings could have significant public health implications in the treatment of resistant hypertension, a major risk factor for heart attack and stroke, said Murray Esler, M.B.B.S., Ph.D., Professor and Senior Director of the Baker IDI Heart and Diabetes Institute in Melbourne, Australia.

　　Hypertension, which is blood pressure higher than 140/90 mm Hg, affects more than 78 million adults in the United States. Among adults with high blood pressure in the United States, about 9 percent have resistant hypertension - meaning they take four or more medications to control their blood pressure, or blood pressure is still higher than 140/90 mm Hg while taking three different blood pressure medicines.

　　"Studies will soon determine whether this procedure can cure mild hypertension, producing permanent drug-free normalization of blood pressure," Esler said. "Based on the blood pressure declines achieved, reduction in heart attack and stroke rates of more than 40 percent is anticipated."

　　Catheter-based renal denervation is a minimally-invasive procedure in which doctors use a catheter, inserted through the femoral artery in the groin, to send radio waves that burn away nerve tissue around the kidney arteries. The goal is to destroy the nerves around the kidneys, which help control and filter salt through the body and may be overactive among patients with hypertension.

　　The results come from Symplicity HTN-2, an ongoing, multicenter, international study evaluating renal denervation for the treatment of hypertension. These findings build on results released in 2010, which showed that six months of treating the nerves around the kidney arteries with radio waves lowered drug-resistant high blood pressure.

　　Participants who began in the control group of the initial study, and did not have the procedure, were invited to "cross over" and receive renal denervation based on the positive outcomes of the patients who had already received the treatment.

　　A total of 35 control patients from the earlier study chose to receive renal denervation and were compared with 47 patients who had been among the first wave of patients to have it. Study participants had drug-resistant hypertension at 160 mm Hg or higher, had taken three or more anti-hypertension drugs, and some had other conditions including diabetes. All had undergone renal artery imaging to ensure the arteries around the kidney could withstand the procedure.

　　In the new study, Esler and his team found that more than 83 percent of the initial renal denervation treatment group experienced a drop in systolic blood pressure of at least 10 mm Hg at six months and nearly 79 percent of the group maintained such reductions at 12 months. The crossover group showed similar results with almost 63 percent reducing systolic blood pressure of 10 mm Hg or more six months after starting the treatment.

　　"Participants' kidneys were not damaged or functionally impaired," Esler said. "We also found no ill effects on long-term health from the procedure."