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題 名 | 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 |
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作 者 | 賴奇正; 黃鴻儒; 馬光遠; 邱春旺; 劉俊鵬; | 書刊名 | 內科學誌 |
卷 期 | 25:5 2014.10[民103.10] |
頁 次 | 頁316-324 |
分類號 | 415.382 |
關鍵詞 | 高血壓治療; 頑固性高血壓; 腎動脈交感神經阻斷術; Hypertension treatment; Resistant hypertension; Renal artery sympathetic nerve denervation; |
語 文 | 中文(Chinese) |
中文摘要 | 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 sympathetic nerve 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 England Journal 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。 |
英文摘要 | 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. |
本系統中英文摘要資訊取自各篇刊載內容。