顽固性高血压的介入治疗肾神经消融ppt课件

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1、顽固性高血压的介入治疗经皮经导管肾神经消融术需要积极稳妥开展临床研究历史回顾降压药物问世前，上世纪20-50年代，尝试外科切除内脏交感神经治疗高血压，虽然降压有效，中/远期生存率明显提高，但围术期的致死、致残率高，中/远期并发症多。尽管当代降压药物有长足发展，但仍有部分规范服药的患者血压不能达标此外：交感神经抑制剂、直接肾素抑制剂、非特异性血管扩张剂、抗高血压疫苗…高血压是全球公共卫生的难题，难治性高血压约占10%-20%，有更高心血管事件风险Resistanthypertension:Circulation2008;117:e510–26理论基础的启示：寻

2、找解决办法Sympatheticnervoussystemandthekidneyinhypertension.Carotidbaroreflexandhypertension肾交感神经阻断？颈动脉体迷走神经兴奋？经导管肾交感神经消融术SymplicityHTN-1ThreeYearandSymplicityHTN-2OneYearSummarySustainedBPReductionstoThreeYearsFirstSymplicityHTN-1patienttreatedJune2007Threeyearreportingshowsnodiminis

3、hmentofeffectandimpressivelongtermsafetyForpatientsthathavecompleted3yearfollowup,100%havebeenclassifiedasresponders(>10mmHgreduction),whileat6months71%ofpatientswereclassifiedasresponders.SuperiorResultsConfirmedinRandomisedStudySymplicityHTN-2treatmentpopulationshowssustainedtrea

4、tmenteffectat12monthfollow-upControlcross-overpatientsalsoshowsignificantBPreductionOnlytheSymplicity™renaldenervationsystemhasprovensafe,superiorandsustainedBPreductionsSignificant,SustainedBloodPressureReductionstoatLeast3YearsExpandedresultspresentedattheAmericanCollegeofCardiol

5、ogyAnnualMeeting2012(Krum,H.)p<0.01forfrombaselineforalltimepointsImpressiveSafetyRecordContinuesinLongTermFollow-up81patientswith6-monthrenalCTA,MRAorduplexNovascularabnormalitiesatanysiteofRFdeliveryOneprogressionofapre-existingstenosisunrelatedtoRFtreatment(stentedwithoutfurthe

6、rsequelae)Onenewmoderatestenosiswhichwasnothemodynamicallyrelevantandnottreated3deathswithinthefollow-upperiod;allunrelatedtothedeviceortherapyNohypotensiveeventsthatrequiredhospitalizationTherewerenoobservedchangesinmeanelectrolytesoreGFRExpandedresultspresentedattheAmericanColleg

7、eofCardiologyAnnualMeeting2012(Krum,H.)PercentageRespondersIncreasesOverTimeResponderwasdefinedasanofficeSBPreduction≥10mmHg(n=143)(n=148)(n=144)(n=130)(n=107)(n=59)(n=24)(n=24)ExpandedresultspresentedattheAmericanCollegeofCardiologyAnnualMeeting2012(Krum,H.)SymplicityHTN-2:RDNSupe

8、riortoMedicalManagement,Re