<International Circulation> :RDN is one of the autonomic modulatory therapies for hypertension， insight from recent year’s clinical research and applications， what do you think the advantages and limitations of this technology? Which patients are more suitable for use?

　　《国际循环》：在高血压的自主神经调节治疗中，肾脏去神经术（RDN）是其中一种方法，通过近年来的临床研究发现，您认为这一技术的优势和局限性有哪些？哪些患者更适合使用？

　　Dr. Fink: I think the major advantage of the renal denervation technology is that it is， in theory anyway， a permanent intervention that would allow a patient to receive the treatment once and at least as far as we know now， the effect on blood pressure seems to be， despite scientific queries on why that might be the case， it seems to be permanent. A big advantage of this method is where a patient would have to take fewer or perhaps even no drugs to manage their hypertension. The big promise of this technique is that it would allow patients to receive a single one time therapy that would control their blood pressure for many many years. Of course no drug is able to do that so in theory it reduces the patient’s need for taking medication， it reduces the cost of treatment， and many studies have now shown that it could be a cost effective therapy if we can select the proper patients to study. This is a big question to the field right now and we do not at this time have any method to select and advance who is likely to respond to renal denervation. Some patients respond very well， others do not respond at all. At this point we are unable to select and advance who will respond so the only way we can find out is to do the renal denervation therapy. Right now， as far as I know， its use is limited only to people with drug resistant hypertension that is people who take 3 or more antihypertensive drugs and do not get an adequate lowering of blood pressure. Currently there is still some question because of the SYMPLICITY HTN-3 trial， as to whether or not this modality of treating hypertension will continue to be explored or not. I believe that there will be additional trials to see where it might fit in to overall hypertension therapy.

　　Fink教授：我认为，肾脏去神经术这一技术的主要优势在于，从理论上讲，它是一种一劳永逸的干预方法。至少据我们所知，其对血压的影响是永久性的，只不过现在还不知道为何其能永久降压。肾脏去神经术的另一大优点是可使患者减少降压药物的应用甚至不再应用降压药物。其最吸引人的地方在于，有望使患者通过一次治疗实现多年血压控制，是任何药物无法做到的。因此，从理论上来说，肾脏去神经术可减少患者的用药需求，降低治疗成本。很多研究已表明，如果选择适宜的患者，肾脏去神经术是一种非常具有成本效益的降压治疗方法。但目前来说，肾脏去神经治疗领域尚存在一个很大的问题，即现在我们还没有一种能识别对肾脏去神经术治疗有应答的患者的方法。有些患者对肾脏去神经术的反应非常好，而有些没有任何反应。要想解决目前无法确定哪些患者会对该治疗方法有反应这一现实问题，我们只能通过不断应用来找到答案。据我所知，目前肾脏去神经术仅限用于难治性高血压患者，即服用至少3种药物后仍无法实现有效控制血压的患者。随着SYMPLICITY HTN-3试验结果的发布，有关是否需要对肾脏去神经术治疗高血压进行进一步探索和研究仍存在很多争议。我认为，未来还会有更多相关试验探讨肾脏去神经术是否可成为高血压患者整体治疗的组成部分。

[1]  [2]  [3]  [4]  下一页