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[GWICC2011]高血压病经皮治疗的现状——Prof Steven R. Bailey访谈

作者:  StevenR.Bailey   日期:2011/11/3 17:48:19

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正如医生们早已了解的那样,我们发现,如果你压迫颈动脉窦,会通过大脑引起非常重要的反应,即减少了交感神经的信号输出而增加了副交感神经的信号输出。通过这种反应可以降低心率——这就是很多医生通过按摩颈动脉窦治疗心律失常的原因。按摩颈动脉窦还可以引起肾脏的直接反应,即减少升压化学物质的释放,增加钠的排泄。


  International Circulation:So, how often do the patients have to come in to receive the treatment?
  《国际循环》:那么,会有多少病人需要接受这种治疗呢?
  PROF BAILEY:That’s the interesting thing: First of all, a lot of the different kinds of high blood pressure we treat are dependent upon this. So that’s important. Essential hypertension, the most common form, but even those associated with obstructive sleep apnea, even preeclampsia, the high blood pressure that affects pregnant women, all seem to be mediated by this. What has been shown is that a single treatment – one time – has sustained effects now out to four and five years in some of the early studies. So it looks like if one can interrupt this, even at a single treatment, that you can have long-term effects, have to take fewer medications, have less high blood pressure, and therefore have less of the end organ damage that occurs.
  PROF BAILEY:这正是这个治疗让人感兴趣的地方。首先,我们处理的许多不同类型的高血压中,很多都与交感神经相关。所以经皮高血压治疗术很重要。其中最常见的原发性高血压,即使是和睡眠呼吸暂停,甚至是先兆子痫(影响孕妇的高血压)相关的高血压,似乎都是由交感神经介导。据早期一些研究显示,接受单次经皮高血压治疗术的患者,迄今为止疗效已经持续了四到五年。因此,看起来只要能够阻断交感神经,即使仅接受单次治疗,也可以起到长期效果,即减少降压药物的服用,降低血压,从而达到减少终末期器官损伤的目的。
  International Circulation:So we’re talking about one 30-40 minute percutaneous treatment that’s going to work for four to five years?
  《国际循环》:所以经皮高血压治疗术是一种通过单次治疗30-40分钟,就可以使疗效持续4-5年的治疗方法?
  PROF BAILEY:We’re talking about one treatment that, so far, has only been looked at for four or five years and is still working. In fact, there’s more decrease in blood pressure — both systolic and diastolic — at two, three, and four years than there was in the first six months. So that’s where the enthusiasm comes from. Now, instead of having to take a medicine there may be a treatment. In fact, most patients with high blood pressure have to take three to five medicines, many of them multiple times a day, to be effective, and it’s still only effective about half the time. So the question becomes: Is there really the opportunity for you, instead of taking three to five medicines everyday for the rest of your life, to have a treatment done that may result in long-term decreases in your blood pressure? Now, as an individual, that’s pretty appealing. As a population strategy, where medications may be difficult or costly, it opens new avenues for thoughts about population-based treatments.
  PROF BAILEY:应该说是一种迄今为止只进行了4-5年的观察,并且疗效还在持续的治疗方法。事实上,在第二、三、四年中,包括收缩压和舒张压在内的血压的降幅,比接受治疗后头六个月中还要大。这就是这个治疗引人入胜之处。现在也许有了一种取代药物治疗的新疗法。现实中,绝大多数高血压患者都需要服用三到五种药物,而且很多药物需要每天多次服用来保证疗效持续,但即使如此,一天之内也只有大约一半时间能达到较好的疗效。所以问题来了:对患者来说,是否确实有机会可以在余生中不用每天吃三到五种药,而可以通过做一次治疗来达到长期降压的效果?对于患者个体来说,这个机会相当有吸引力。而对高血压人群治疗策略而言,药物治疗难以规范普及,而且花费巨大,而经皮高血压治疗术则为高血压人群的治疗开创了一条新思路。

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