Device-based antihypertensive treatments have primarily been developed and clinically tested for patients with hypertension refractory to pharmacological treatment. Most but not all device-based treatments target the sympathetic nervous system and provided important new insight in the mechanisms of human hypertension. This review provides an overview on the scientific rational and clinical data on recent device-based antihypertensive treatment approaches. Device-based treatments targeting the sympathetic nervous system include catheter-based renal nerve ablation, electrical carotid sinus stimulation, modulation of baroreflex transduction through a dedicated carotid stent, carotid body denervation, and deep brain stimulation. Creation of a defined arteriovenous stent with a coupler device and removal of stimulatory antibodies against alpha adrenoreceptors have also been tested. The clinical evidence differs from therapy to therapy with the largest dataset for renal nerve ablation followed by electrical carotid sinus stimulation. Yet, none has been proven efficacious in sham-controlled clinical trials, and none has been shown to reduce cardiovascular morbidity or mortality. Before efficacy is proven, these treatments should not be part of routine medical care and only be applied in the setting of clinical studies.

译文

基于设备的抗高血压治疗主要是针对药物治疗难治的高血压患者开发和临床测试的。大多数但不是所有基于设备的治疗都针对交感神经系统,并为人类高血压的机制提供了重要的新见解。这篇综述概述了有关基于设备的降压治疗方法的科学合理和临床数据。针对交感神经系统的基于设备的治疗包括基于导管的肾神经消融,颈动脉窦电刺激,通过专用颈动脉支架调节压力反射传导,颈动脉体去神经支配和深部脑刺激。还测试了使用耦合器装置创建定义的动静脉支架并去除针对 α 肾上腺素受体的刺激抗体。临床证据因治疗而异,其最大数据集用于肾神经消融,然后进行颈动脉窦电刺激。然而,在假对照临床试验中,没有一项被证明是有效的,也没有一项被证明可以降低心血管疾病的发病率或死亡率。在证明疗效之前,这些治疗方法不应成为常规医疗保健的一部分,而仅适用于临床研究。

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