<International Circulation>:  What do you think the future is for renal denervation?  Do you think this is a promising therapy?

　　《国际循环》：您认为肾脏去神经治疗将是一种很有前途的治疗吗？
　　Prof. Oparil: I think it is very exciting.  It is new and promising and like it， in part because it has a very strong scientific basis.  Thirty years ago we did a lot of studies on animal models， using hypertensive rats having received steroids or a surgical narrowing of their renal artery to make them hypertensive， where we removed renal nerves in all models you can prevent hypertension or attenuate it if it is already present.  The bad news is that the renal nerves grow back if it is done peripherally.  In humans the nerves seem to not grow back as much or if they do they have diminished functionality， although that remains to be validated.  We know that the autonomic nervous system plays a tremendous function in blood pressure control， not only at the steady-state level but also in controlling fluctuations， which are turning out to be prognostically important and independent of mean blood pressure.  There is not a real good way to deal with fluctuations because drugs like beta-blockers don’t work well for central nervous system output.  If you there is sympathetic activation blood pressure increases markedly and the heart rate quickens， there is renal vasoconstriction to retain salt and water， everything is affected.  The class of drugs that affects that are the centrally acting agents like clonidine， which is very difficult to tolerate and make people sleepy.  They also don’t have adequate outcome data to support their use so few people use them.  Renal denervation is relatively simple， can be done by an interventional cardiologist easily in a few minutes， but is somewhat costly they way it is being done now with patients being required to be in the hospital overnight for monitoring.  Because there is a groin puncture with risks of hematoma and because the blood pressure could drop overnight monitoring is necessary.  There is an increasing proportion of people whose blood pressure cannot be controlled with usual therapies， so this procedure could be used on them.  I used to say that you could control everyone’s blood pressure， but that is not true.  Maybe 15% of people cannot be controlled， a rate that is increasing because of increasing age and obesity.  If a patient has hypertension for a long time， even if it is controlled well with medicine， you could gradually escape control.  This is because blood vessels get stiffer and kidneys deteriorate a little.  Things deteriorate normally due to age related changes and with complications like hypertension or diabetes the deterioration goes faster.  In an older， fatter， sedentary population with diabetes there is a lot more resistant hypertension and a need for new therapies.

　　Oparil教授：我认为该治疗是非常令人兴奋的，新颖但有前途，我赞同你的说法，因为它有很坚实的科学基础。30年前，我们在动物模型上开展了许多研究。使用类固醇药物或肾动脉狭窄手术制备高血压模型大鼠，然后去除所有模型鼠的肾神经，可以预防高血压或降低已有的高血压水平。但其缺点是肾神经可能在外围增长。但在人类，如果已经功能性萎缩，神经似乎不会继续增长，尽管这有待验证。众所周知，自主神经系统在血压调控发挥着举足起重的作用，不仅是稳态水平还包括控制血压波动，这说明自主神经具有预测的重要性且独立于平均血压水平。目前尚无真正好的方法治疗血压波动，因为像β-受体阻滞剂这类药物并不能很好地作用于中枢神经系统输出通路。如果你的交感神经兴奋，那么血压会明显增加、心??率加快、肾血管收缩，钠水潴留，这一切都受到影响。而像可乐定这类作用于中构神经系统药物则让人难以耐受，且让人昏昏欲睡，目前也没有足够的研究数据证明它的使用效果，所以很少有人会服用它们。肾脏去神经治疗相对比较简单，心脏病学介入专家在几分钟内轻松完成，但这种治疗费用有些昂贵，且患者必须在医院接受通宵监测。因为存在腹股沟穿刺血肿和血压骤降的风险，因此，通宵监测是必须的。通过常规治疗仍未有效控制血压的患者比例逐渐上升，因此这类患者可以采取这种治疗。我曾说过每个人的血压都可以控制，但事实并非如此。大约有15%患者的血压得不到控制，这一比例随着年龄的增加和肥胖而增加。如果患者的高血压时期很长，甚至通过药物获得了很好的控制，血压仍会逐渐失去控制，这是因为血管变得更硬，肾脏出现轻微恶化。通常与年龄相关的变化及高血压或糖尿病等并发症，导致血压失控的发展更快。在年老、肥胖、久坐的糖尿病人群中，有许多顽固性高血压需要采用新的治疗方法。