Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

被引：107

作者：

Barbato, Emanuele ^{[1
]}

Azizi, Michel ^{[2
,3
,4
]}

Schmieder, Roland E. ^{[5
,6
]}

Lauder, Lucas ^{[7
,8
,9
]}

Boehm, Michael ^{[7
,8
,9
]}

Brouwers, Sofie ^{[10
,11
]}

Bruno, Rosa Maria ^{[2
,12
]}

Dudek, Dariusz ^{[13
,14
]}

Kahan, Thomas ^{[15
,16
,17
]}

Kandzari, David E. ^{[18
]}

Luscher, Thomas F. ^{[19
,20
,21
,22
]}

Parati, Gianfranco ^{[23
,24
]}

Pathak, Atul ^{[25
]}

Ribichini, Flavio L. ^{[26
]}

Schlaich, Markus P. ^{[27
,28
,29
,30
]}

Sharp, Andrew S. P. ^{[31
]}

Sudano, Isabella ^{[32
]}

Volpe, Massimo ^{[33
]}

Tsioufis, Costas ^{[34
,35
]}

Wijns, William ^{[36
,37
]}

Mahfoud, Felix ^{[7
,8
,9
]}

机构：

[1] Sapienza Univ Rome, Dept Clin & Mol Med, Rome, Italy

[2] Univ Paris Cite, Paris Ctr Rech Cardiovasc, INSERM, Paris, France

[3] Hop Europeen Georges Pompidou, AP HP, Hypertens Dept, Paris, France

[4] Univ Lorraine, FCRIN INI CRCT, Nancy, France

[5] Univ Hosp Erlangen, Dept Nephrol & Hypertens, Erlangen, Germany

[6] Friedrich Alexander Univ Erlangen Nurnberg, Erlangen, Germany

[7] Univ Klinikum Saarlandes, Klin Innere Med 3, Homburg, Germany

[8] Saarland Univ, Homburg, Germany

[9] OLV Hosp Aalst, Cardiovasc Ctr Aalst, Aalst, Belgium

[10] Vrije Univ Brussel, Fac Med & Pharm, Dept Expt Pharmacol, Brussels, Belgium

[11] Hop Europeen Georges Pompidou, AP HP, Pharmacol Unit, Paris, France

[12] Jagiellonian Univ, Inst Cardiol, Med Coll, Krakow, Poland

[13] Maria Cecilia Hosp, GVM Care & Res, Cotignola, Italy

[14] Karolinska Inst, Dept Clin Sci, Solna, Sweden

[15] Danderyd Hosp, Div Cardiovasc Med, Stockholm, Sweden

[16] Danderyd Univ Hosp Corp, Dept Cardiol, Stockholm, Sweden

[17] Piedmont Heart Inst, Atlanta, GA USA

[18] Royal Brompton & Harefield Hosp, Dept Cardiol, London, England

[19] Imperial Coll, Natl Heart & Lung Inst, London, England

[20] Kings Coll London, Sch Cardiovasc Med & Sci, London, England

[21] Univ Zurich, Ctr Mol Cardiol, Schlieren, Switzerland

[22] Univ Milano Bicocca, Dept Med & Surg, Milan, Italy

[23] IRCCS, Ist Auxol Italiano, Cardiol Unit, Milan, Italy

[24] Ctr Hosp Princesse Grace, Dept Cardiovasc Med, Monte Carlo, Monaco

[25] Univ Verona, Dept Med, Div Cardiol, Verona, Italy

[26] Dobney Hypertens Ctr, Med Sch, Perth, WA, Australia

[27] Univ Western Australia, Royal Perth Hosp Unit, Med Res Fdn, Perth, WA, Australia

[28] Royal Perth Hosp, Dept Cardiol & Nephrol, Perth, WA, Australia

[29] Univ Hosp Wales, Dept Cardiol, Cardiff, Wales

[30] Univ Hosp Zurich, Univ Heart Ctr, Dept Cardiol, Zurich, Switzerland

[31] Sapienza Univ Rome, St Andrea Hosp, Dept Cardiol, Rome, Italy

[32] Natl & Kapodistrian Univ Athens, Dept Cardiol 1, Athens, Greece

[33] Hippocratio Hosp, Athens, Greece

[34] Lambe Inst Translat Med, Galway, Ireland

[35] Univ Galway, Galway, Ireland

[36] Smart Sensors Lab, London, England

[37] CURAM, London, England

来源：

EUROPEAN HEART JOURNAL | 2023年 / 44卷 / 15期

关键词：

hypertension; renal sympathetic denervation; resistant hypertension; uncontrolled hypertension; AMBULATORY BLOOD-PRESSURE; SHAM-CONTROLLED TRIAL; SYMPATHETIC DENERVATION; RISK-FACTORS; UNCONTROLLED HYPERTENSION; ATRIAL-FIBRILLATION; SYMPLICITY HTN-3; HEART-FAILURE; END-POINT; CATHETER;

D O I：

10.1093/eurheartj/ehad054

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.

引用

页码：1313 / 1330

页数：18

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