Рефрактерная артериальная гипертония в современной кардиологии является актуальной проблемой, приводящей к развитию таких осложнений, как инфаркт миокарда, мозговой инсульт, и, как следствие, к ранней инвалидизации больных. Появление такого немедикаментозного метода, как радиочастотная денервация почечных артерий, в комплексной гипотензивной терапии позволяет рассчитывать на достижение контроля над артериальным давлением и, соответственно, снижение риска развития сердечно-сосудистых осложнений. В данной статье представлено актуальное состояние вопроса об использовании данного метода в клинической практике.
Resistant hypertension is an urgent problem in modern cardiology, leading to myocardial infarction, stroke, and, as a consequence, early disability of patients. The emergence of such a method as radiofrequency denervation of the renal arteries in the complex antihypertensive therapy can expect to achieve control of blood pressure and thus reduce the risk of cardiovascular complications. This article presents the current state of the use of this method in clinical practice.
1. Российское медицинское общество по артериальной гипертонии – Всероссийское научное общество кардиологов. Диагностика и лечение артериальной гипертензии. Российские рекомендации (третий пересмотр). М., 2008. / Rossiiskoe meditsinskoe obshchestvo po arterial'noi gipertonii – Vserossiiskoe nauchnoe obshchestvo kardiologov. Diagnostika i lechenie arterial'noi gipertenzii. Rossiiskie rekomendatsii (tretii peresmotr). M., 2008. [in Russian]
2. Dam-Marx C, Ye X, Sung JC et al. Results of a retrospective, observational pilot study using electronic medical records to assess the prevalence and characteristics of patients with resistant hypertension in an ambulatory care setting. Clin Ther 2009; 31 (5): 1116–23.
3. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003; 290: 199–206.
4. Cushman WC, Ford CE, Cutler JA et al. For the ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering and Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens 2002; 4: 393–404.
5. Garg JP, Elliott WJ, Folker A et al. Resistant hypertension revisited: a comparison of two university-based cohorts. Am J Hypertens 2005; 18 (5): 619–26.
6. Marshall EK, Kolls AC. Studies on the nervous control of the kidney in relation to diuresis and urinary secretion. I. The effect of unilateral excision of the adrenal, section of the splanchnic nerve and section of the renal nerves on the secretion of the kidney. Am J Physiol 1919; 49: 302.
7. Blake WD, Jurf AN. Renal sodium reabsorption after acute renal denervation in the rabbit. J Physiol (Lond) 1968; 196: 65.
8. Bello-Reuss E, Colindres R, Pastoriza-Munoz E et al. Effects of acute unilateral renal denervation in the rat. J Clin Invest 1975; 56: 208.
9. Vander AJ. Effect of catecholamines and the renal nerves on rеnin secretion in anesthetized dogs. Am J Physiol 1965; 209: 659.
10. Brown JJ, Davics DL, Lever AF et al. Plasma renin concentration in relation to changes in posture. Clin Sci 1966; 30: 279.
11. DiBona GF. Sympathetic nervous system and the kidney in hypertension. Curr Opin Nephrol Hypertens 2002; 11: 197–200.
12. Kottke FJ, Kubicck WG, Visscher MB. The production of arterial hypertension by chronic renal artery-nerve stimulation. Am J Physiol 1945; 145: 38.
13. O’Hagan KP, Thomas GD, Zambraski EJ. Renal denervation decreases blood pressure in DOCA-treated miniature swine with established hypertension. Am J Hypertens 1990; 3: 62–4.
14. Liard JF. Renal denervation delays blood pressure increase in the spontaneously hypertensive rat. Experientia (Basel) 1977; 33: 339.
15. Winternitz SR, Katholi RE, Oparil S. Role of the renal sympathetic nerves in the development and maintenance of hypertension in the spontaneously hypertensive rat. J Clin Invest 1980; 66: 971.
16. Ueda H, Uchida Y, Kamisaka K. Mechanisms of the reflex depressor effect by kidney in dog. Jpn Heart J 1967; 8: 597.
17. Calaresu FR, Kim P, Nakamura H, Sato A. Electrophysiological characteristics of renorenal reflexes in the cat. J Physiol 1978; 283: 141.
18. Francisco LL, Hoverstein LG, DiBona GF. Renal nerves in the compensatory adaptation to ureteral occlusion. Am J Physiol 1980; 238: F229.
19. Calaresu FR, Ciriello J. Renal afferent nerves affect discharge rate of medullary and hypothalamic single units in the cat. J Autonomic Nervous System 1981; 3: 311.
20. Schlaich MP, Lambert E, Kaye DM et al. Sympathetic augmentation in hypertension: role of nerve firing, norepinephrine reuptake, and angiotensin neuromodulation. Hypertension 2004; 43: 169–75.
21. Kaye DM, Lambert GW, Lefkovits J et al. Neurochemical evidence of cardiac sympathetic activation and increased central nervous system norepinephrine turnover in severe congestive heart failure. J Am Coll Cardiol 1994; 23: 570–8.
22. Keith NM, Wagener HP, Kemohan JW. Arch Intern Med 1928; 41: 141.
23. Bradford C. The effects of progressive sympathectomy on blood pressure. Am J Physiol 1931; 592–6.
24. Hinton JW. Operative technique of thoracolumbar sympathectomy. Surg Gynec Obstet 1946; 84: 643.
25. Peet M, Woods W, Braden S. The surgical treatment of hypertension. JAMA 1940; 115: 1875.
26. Smithwick R. Technique for splanchnic resection for hypertension; preliminary report, Surgery 1940; 7: 10.
27. Page I, Heuer G. A surgical treatment of essential hypertension. J Clin Invest 1935; 14 (1): 22–6.
28. Allen EV. Sympathectomy for Essential Hypertension. Circulation 1952; 6: 131–40.
29. Kearney PM, Whelton M, Reynolds K et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217–23.
30. Stuart M. Masterminds of Ardian: An Interview With Inventors Mark Gelfand and Howard Levin. Start-Up. 2011.
31. Rippy M, Zarins D. Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety. Clin Res Cardiol 2011.
32. Krum H, Schlaich M, Whitbourn R et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-ofprinciple cohort study. Lancet 2009; 373 (9671): 1275–81.
33. Данилов Н.М., Матчин Ю.Г., Чазова И.Е. Эндоваскулярная радиочастотная денервация почечных артерий – инновационный метод лечения рефрактерной артериальной гипертонии. Первый опыт в России. Ангиология и сосудистая хирургия. 2012; с. 51–3. / Danilov N.M., Matchin Iu.G., Chazova I.E. Endovaskuliarnaia radiochastotnaia denervatsiia pochechnykh arterii ‒ innovatsionnyi metod lecheniia refrakternoi arterial'noi gipertonii. Pervyi opyt v Rossii. Angiologiia i sosudistaia khirurgiia. 2012; s. 51–3. [in Russian]
34. Матчин Ю.Г., Григин В.А., Данилов Н.М. и др. Радиочастотная денервация почечных артерий в лечении рефрактерной артериальной гипертонии – результаты годичного наблюдения. Атмосфера. Новости кардиологии. 2013; 3: 12–8. / Matchin Iu.G., Grigin V.A., Danilov N.M. i dr. Radiochastotnaia denervatsiia pochechnykh arterii v lechenii refrakternoi arterial'noi gipertonii – rezul'taty godichnogo nabliudeniia. Atmosfera. Novosti kardiologii. 2013; 3: 12–8. [in Russian]
35. Schlaich M. Expanded results presented at the Transcatheter Cardiovascular Therapeutics Annual Meeting. 2012.
36. Symplicity HTN-1 Investigators. Hypertension 2011; 57: 911–7.
37. Esler M, Krum H, Sobotka PA et al. Symplicity HTN-2 Investigators. Lancet 2010; 376: 1903–9.
38. Bhatt D, Kandzari D, O’Neill W et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370: 1393–401.
39. Sakakura K, Ladich E, Cheng Q et al. Anatomical distribution of human renal sympathetic nerves: pathological study. J Am Coll Cardiol 2014; 63.
40. Böhm M, Mahfoud F, Ukena C et al. Rationale and design of a large registry on renal denervation: the Global SYMPLICITY registry. EuroIntervention 2013; 9 (4): 484–92.
41. Mahfoud F, Schlaich M, Kindermann I et al. Effect of Renal Sympathetic Denervation on Glucose Metabolism in Patients With Resistant Hypertension. Circulation 2011; 123: 1940–6.
42. Witkowski A, Prejbisz A, Florczak E et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension 2011; 58: 559–65.
43. Tsioufis C, Papademetriou V et al. Renal denervation for sleep apnea and resistant hypertension: an alternative or complementary to effective CPAP treatment? Hypertension 2011; 58: e191.
44. Ukena C, Mahfoud F, Spies A et al. Effects of renal sympathetic denervation on heart rate and atrioventricular conduction in patients with resistant hypertension. Int J Cardiol 2013; 167 (6): 2846–51.
45. Pokushalov E, Romanov A, Corbucci G et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol 2012; 60 (13): 1163–70.
46. Davis MI, Filion KB, Zhang D et al. Effectiveness of renal denervation therapy for resistant hypertension: A systematic review and meta-analysis. J Am Coll Cardiol 2013.
47. Whitbourn R, Harding S, Rothman M et al. Renal artery denervation with a new simultaneous multielectrode catheter for treatment of resistant hypertension: results from the Symplicity Spyral first-in-man study [abstract]. J Am Coll Cardiol 2013; 62: B150.
48. Worthley S. Longer term safety and efficacy of catheter-based renal sympathetic denervation using a multi-electrode renal artery denervation catheter in patients with drug resistant essential hypertension: 24 Month Results of a first-in-human, multicenter study – EnligHTN I; Presented at EuroPCR, Paris, France, 2014.
49. Ahmed H, Neuzil P, Skoda J et al. Renal sympathetic denervation using an irrigated radiofrequency ablation catheter for the management of drug-resistant hypertension. JACC Cardiovasc Interv 2012; 5: 758–65.
50. Verheye S, Ormiston J, Bergmann M et al. Twelve-month results of the Rapid Renal Sympathetic Denervation for Resistant Hypertension Using the OneShotTM Ablation System (RAPID) study. EuroIntervention 2015; 10: 1221–9.
51. Mazor M, Baird R, Stanley J. Evaluation of acute, sub-acute, and chronic renal artery nerve morphological changes following bipolar radiofrequency renal denervation treatment in the porcine model [abstract]. J Am Coll Cardiol 2013; 62: B150.
52. Honton B, Pathak A, Sauguet A, Fajadet J. First report of transradial renal denervation with the dedicated radiofrequency IberisTM catheter. EuroIntervention 2013; 9-online publish-ahead-of-print October 2013.
53. Heuser R, Mhatre A, Buelna T et al. A novel non-vascular system to treat resistant hypertension. EuroIntervention 2013; 9: 135–9.
________________________________________________
1. Rossiiskoe meditsinskoe obshchestvo po arterial'noi gipertonii – Vserossiiskoe nauchnoe obshchestvo kardiologov. Diagnostika i lechenie arterial'noi gipertenzii. Rossiiskie rekomendatsii (tretii peresmotr). M., 2008. [in Russian]
2. Dam-Marx C, Ye X, Sung JC et al. Results of a retrospective, observational pilot study using electronic medical records to assess the prevalence and characteristics of patients with resistant hypertension in an ambulatory care setting. Clin Ther 2009; 31 (5): 1116–23.
3. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003; 290: 199–206.
4. Cushman WC, Ford CE, Cutler JA et al. For the ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering and Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens 2002; 4: 393–404.
5. Garg JP, Elliott WJ, Folker A et al. Resistant hypertension revisited: a comparison of two university-based cohorts. Am J Hypertens 2005; 18 (5): 619–26.
6. Marshall EK, Kolls AC. Studies on the nervous control of the kidney in relation to diuresis and urinary secretion. I. The effect of unilateral excision of the adrenal, section of the splanchnic nerve and section of the renal nerves on the secretion of the kidney. Am J Physiol 1919; 49: 302.
7. Blake WD, Jurf AN. Renal sodium reabsorption after acute renal denervation in the rabbit. J Physiol (Lond) 1968; 196: 65.
8. Bello-Reuss E, Colindres R, Pastoriza-Munoz E et al. Effects of acute unilateral renal denervation in the rat. J Clin Invest 1975; 56: 208.
9. Vander AJ. Effect of catecholamines and the renal nerves on rеnin secretion in anesthetized dogs. Am J Physiol 1965; 209: 659.
10. Brown JJ, Davics DL, Lever AF et al. Plasma renin concentration in relation to changes in posture. Clin Sci 1966; 30: 279.
11. DiBona GF. Sympathetic nervous system and the kidney in hypertension. Curr Opin Nephrol Hypertens 2002; 11: 197–200.
12. Kottke FJ, Kubicck WG, Visscher MB. The production of arterial hypertension by chronic renal artery-nerve stimulation. Am J Physiol 1945; 145: 38.
13. O’Hagan KP, Thomas GD, Zambraski EJ. Renal denervation decreases blood pressure in DOCA-treated miniature swine with established hypertension. Am J Hypertens 1990; 3: 62–4.
14. Liard JF. Renal denervation delays blood pressure increase in the spontaneously hypertensive rat. Experientia (Basel) 1977; 33: 339.
15. Winternitz SR, Katholi RE, Oparil S. Role of the renal sympathetic nerves in the development and maintenance of hypertension in the spontaneously hypertensive rat. J Clin Invest 1980; 66: 971.
16. Ueda H, Uchida Y, Kamisaka K. Mechanisms of the reflex depressor effect by kidney in dog. Jpn Heart J 1967; 8: 597.
17. Calaresu FR, Kim P, Nakamura H, Sato A. Electrophysiological characteristics of renorenal reflexes in the cat. J Physiol 1978; 283: 141.
18. Francisco LL, Hoverstein LG, DiBona GF. Renal nerves in the compensatory adaptation to ureteral occlusion. Am J Physiol 1980; 238: F229.
19. Calaresu FR, Ciriello J. Renal afferent nerves affect discharge rate of medullary and hypothalamic single units in the cat. J Autonomic Nervous System 1981; 3: 311.
20. Schlaich MP, Lambert E, Kaye DM et al. Sympathetic augmentation in hypertension: role of nerve firing, norepinephrine reuptake, and angiotensin neuromodulation. Hypertension 2004; 43: 169–75.
21. Kaye DM, Lambert GW, Lefkovits J et al. Neurochemical evidence of cardiac sympathetic activation and increased central nervous system norepinephrine turnover in severe congestive heart failure. J Am Coll Cardiol 1994; 23: 570–8.
22. Keith NM, Wagener HP, Kemohan JW. Arch Intern Med 1928; 41: 141.
23. Bradford C. The effects of progressive sympathectomy on blood pressure. Am J Physiol 1931; 592–6.
24. Hinton JW. Operative technique of thoracolumbar sympathectomy. Surg Gynec Obstet 1946; 84: 643.
25. Peet M, Woods W, Braden S. The surgical treatment of hypertension. JAMA 1940; 115: 1875.
26. Smithwick R. Technique for splanchnic resection for hypertension; preliminary report, Surgery 1940; 7: 10.
27. Page I, Heuer G. A surgical treatment of essential hypertension. J Clin Invest 1935; 14 (1): 22–6.
28. Allen EV. Sympathectomy for Essential Hypertension. Circulation 1952; 6: 131–40.
29. Kearney PM, Whelton M, Reynolds K et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217–23.
30. Stuart M. Masterminds of Ardian: An Interview With Inventors Mark Gelfand and Howard Levin. Start-Up. 2011.
31. Rippy M, Zarins D. Catheter-based renal sympathetic denervation: chronic preclinical evidence for renal artery safety. Clin Res Cardiol 2011.
32. Krum H, Schlaich M, Whitbourn R et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-ofprinciple cohort study. Lancet 2009; 373 (9671): 1275–81.
33. Danilov N.M., Matchin Iu.G., Chazova I.E. Endovaskuliarnaia radiochastotnaia denervatsiia pochechnykh arterii ‒ innovatsionnyi metod lecheniia refrakternoi arterial'noi gipertonii. Pervyi opyt v Rossii. Angiologiia i sosudistaia khirurgiia. 2012; s. 51–3. [in Russian]
34. Matchin Iu.G., Grigin V.A., Danilov N.M. i dr. Radiochastotnaia denervatsiia pochechnykh arterii v lechenii refrakternoi arterial'noi gipertonii – rezul'taty godichnogo nabliudeniia. Atmosfera. Novosti kardiologii. 2013; 3: 12–8. [in Russian]
35. Schlaich M. Expanded results presented at the Transcatheter Cardiovascular Therapeutics Annual Meeting. 2012.
36. Symplicity HTN-1 Investigators. Hypertension 2011; 57: 911–7.
37. Esler M, Krum H, Sobotka PA et al. Symplicity HTN-2 Investigators. Lancet 2010; 376: 1903–9.
38. Bhatt D, Kandzari D, O’Neill W et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370: 1393–401.
39. Sakakura K, Ladich E, Cheng Q et al. Anatomical distribution of human renal sympathetic nerves: pathological study. J Am Coll Cardiol 2014; 63.
40. Böhm M, Mahfoud F, Ukena C et al. Rationale and design of a large registry on renal denervation: the Global SYMPLICITY registry. EuroIntervention 2013; 9 (4): 484–92.
41. Mahfoud F, Schlaich M, Kindermann I et al. Effect of Renal Sympathetic Denervation on Glucose Metabolism in Patients With Resistant Hypertension. Circulation 2011; 123: 1940–6.
42. Witkowski A, Prejbisz A, Florczak E et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension 2011; 58: 559–65.
43. Tsioufis C, Papademetriou V et al. Renal denervation for sleep apnea and resistant hypertension: an alternative or complementary to effective CPAP treatment? Hypertension 2011; 58: e191.
44. Ukena C, Mahfoud F, Spies A et al. Effects of renal sympathetic denervation on heart rate and atrioventricular conduction in patients with resistant hypertension. Int J Cardiol 2013; 167 (6): 2846–51.
45. Pokushalov E, Romanov A, Corbucci G et al. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension. J Am Coll Cardiol 2012; 60 (13): 1163–70.
46. Davis MI, Filion KB, Zhang D et al. Effectiveness of renal denervation therapy for resistant hypertension: A systematic review and meta-analysis. J Am Coll Cardiol 2013.
47. Whitbourn R, Harding S, Rothman M et al. Renal artery denervation with a new simultaneous multielectrode catheter for treatment of resistant hypertension: results from the Symplicity Spyral first-in-man study [abstract]. J Am Coll Cardiol 2013; 62: B150.
48. Worthley S. Longer term safety and efficacy of catheter-based renal sympathetic denervation using a multi-electrode renal artery denervation catheter in patients with drug resistant essential hypertension: 24 Month Results of a first-in-human, multicenter study – EnligHTN I; Presented at EuroPCR, Paris, France, 2014.
49. Ahmed H, Neuzil P, Skoda J et al. Renal sympathetic denervation using an irrigated radiofrequency ablation catheter for the management of drug-resistant hypertension. JACC Cardiovasc Interv 2012; 5: 758–65.
50. Verheye S, Ormiston J, Bergmann M et al. Twelve-month results of the Rapid Renal Sympathetic Denervation for Resistant Hypertension Using the OneShotTM Ablation System (RAPID) study. EuroIntervention 2015; 10: 1221–9.
51. Mazor M, Baird R, Stanley J. Evaluation of acute, sub-acute, and chronic renal artery nerve morphological changes following bipolar radiofrequency renal denervation treatment in the porcine model [abstract]. J Am Coll Cardiol 2013; 62: B150.
52. Honton B, Pathak A, Sauguet A, Fajadet J. First report of transradial renal denervation with the dedicated radiofrequency IberisTM catheter. EuroIntervention 2013; 9-online publish-ahead-of-print October 2013.
53. Heuser R, Mhatre A, Buelna T et al. A novel non-vascular system to treat resistant hypertension. EuroIntervention 2013; 9: 135–9.
Авторы
В.А.Григин, Н.М.Данилов*, Ю.Г.Матчин, И.Е.Чазова
ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*ndanilov1@gmail.com
Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
*ndanilov1@gmail.com