Περίληψη:
The interest in RDN for hypertension has fluctuated recently, with a flurry of initial enthusiasm followed by sudden loss of interest by researchers and device manufacturers, with an almost as sudden resurgence in clinical trials activity and device innovation more recently. There is widespread consensus that this therapeutic strategy can be effective, at least for some of the technologies available. Major uncertainties remain as to the clinical role of RDN, and whether any of the emerging technologies such as AV-anastomosis formation, carotid body ablation, carotid bulb expansion, or baroreflex stimulation will have a future as effective treatment options in patients with hypertension. In our first consensus report in 2015, the European Expert Group pointed to the major unmet need of standardization of measurements, trial design and procedural performance.6 With the large number of different technologies currently in the pipeline, this need has even increased. Only through high-quality, collaborative research and openness to new methods for recruitment, patient selection, and assessment of outcomes will it be possible to establish incontrovertibly whether device therapies for hypertension are effective and what are preferred patient populations. Once the proof of concept is established, further studies with a design relevant to clinical reality will be needed to establish the place of new devices in the treatment armoury. The clinical and research community has a large responsibility to prove or disprove the value of new therapies, in order to ensure that antihypertensive devices provide future patients with the greatest benefit and the smallest risk. copy; The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology.
Συγγραφείς:
Mahfoud, F.
Schmieder, R.E.
Azizi, M.
Pathak, A.
Sievert, H.
Tsioufis, C.
Zeller, T.
Bertog, S.
Blankestijn, P.J.
Böhm, M.
Burnier, M.
Chatellier, G.
Zaleski, I.D.
Ewen, S.
Grassi, G.
Joner, M.
Kjeldsen, S.E.
Lobo, M.D.
Lotan, C.
Lüscher, T.F.
Parati, G.
Rossignol, P.
Ruilope, L.
Sharif, F.
Van Leeuwen, E.
Volpe, M.
Windecker, S.
Witkowski, A.
Wijns, W.
Λέξεις-κλειδιά:
spironolactone, arteriovenous fistula; blood pressure regulation; carotid sinus pressoreceptor reflex; consensus; device therapy; futurology; hypertension; kidney denervation; outcome assessment; priority journal; randomized controlled trial (topic); resistant hypertension; Review; blood pressure; catheter ablation; consensus; devices; equipment design; Europe; human; hypertension; innervation; kidney; medical society; organization; pathophysiology; physiology; practice guideline; sympathectomy, Blood Pressure; Catheter Ablation; Congresses as Topic; Consensus; Equipment Design; Europe; Humans; Hypertension; Kidney; Practice Guidelines as Topic; Societies, Medical; Sympathectomy
