<International Circulation>: Renal denervation works on resistant hypertension?  And does it actually bring the blood pressure down or just attenuate it?

　　《国际循环》：肾脏去神经治疗是否可以治疗顽固性高血压？它可以实质性地降低血压还只是缓解症状？
　　Prof. Oparil: So far it has only been used for resistant hypertension， as this is the only indication for the procedure.  It does bring down the pressure.  It doesn’t normalize the pressure though.  This is not approved in the United States yet， although there have been studies done in the US.  The blood pressure reduction was 32/12mmHg from a starting pressure of 180/105， so it didn’t normalize it completely.  They did not try withdrawing medications in these patients， which would be the next step.  If there were better control you wouldn’t need as many medicines.

　　Oparil教授：目前，肾脏去神经治疗已用于治疗顽固性高血压，也是该治疗的唯一适应症。该手术可以降低血压，但并不能将血压控制在正常范围。目前美国尚未批准此项手术治疗，尽管已经在美国开展过相关研究。血压从最初的180/105 mmHg降低32/12mmHg，因此，并未完全控制在正常水平。这类患者并未尝试停止服用药物，可能下一步开展相关研究。如果有更好的控制方法，那就没必要继续使用大量药物。

　　<International Circulation>: Nobody has tried withdrawing medications yet?

　　《国际循环》：没有任何患者放弃药物治疗么？
　　Prof. Oparil: Some have but the studies were design so that the group receiving normal medications served as the control.  SIMPLICITY II is the big randomized control trial that has recently finished was published in Lancet and had 50 patients per group with starting pressures of 180/105mmHg.  The study was randomized and patients were on an average of 5 drugs.  One group received the denervation and the other did not and continued on their regular medicine.  In comparison to the control， whose blood pressure did not change over the six-month follow-up， the group receiving the denervation went down by 32/12 mmHg.  There is definite benefit.  They have also shown that in subsets of those patients who had metabolic syndrome， or insulin resistance， also had improvement in this condition with the renal denervation.  This is probably due to the improvements of blood flow to muscle and the subsequent increase in glucose uptake by myocytes.  They have shown that polycystic ovaries， a condition affecting mildly overweight， hairy women who have insulin resistance and high blood pressure had improvement.  There was a small study from Poland where it improved sleep apnea.  All of these results are positive.  It is still early however， and you don’t know if there were any patients didn’t respond at all， whether there will be a subset that is not going to respond or whether the benefit will go away over time.  They have published 24-month follow-up data with a small number of people.

　　Oparil教授：有些患者放弃了药物治疗，但研究通常是将服用常规药物的患者作为对照组。SIMPLICITY II 是一个大型的随机对照试验，最近完成的研究发表在柳叶刀杂志。该研究中，每组共有50例患者，其初始血压180/105mmHg；
　　患者随机服用5种药物。其中一组患者接受去神经治疗，其它组患者则继续常规降压药物治疗。对照组患者的血压在6个月的随访期间均未发生变化，与对照组相比，去神经治疗组血压下降32/12 mmHg，该治疗呈现一定的疗效。研究表明，在代谢症候群或胰岛素抵抗的亚组患者中，去神经治疗也能改善血压的控制。这可能是因为改善了肌肉流向的血流及提高肌细胞对葡萄糖的摄取。研究表明，在多囊卵巢且轻度超重，多毛症伴胰岛素抵抗和高血压的妇女，去神经治疗可改善血压控制。一个来自波兰的小型研究表明去神经治疗可改善睡眠呼吸暂停综合症。所有这些研究都是阳性结果。这仍是早期研究，然而，你并不知道是否会有患者对该治疗无应答，是否会有部分患者的疗效会随着时间推移而下降。他们发表了小部分患者为期24个月的随访研究数据。

　　<International Circulation>: In animal models， how long does it take the nerves to grow back?  For humans how long could it take?

　　《国际循环》：在动物模型中，神经重新生长出来需要多长时间？对于人类则需多久？
　　Prof. Oparil:  In rats just 6 weeks， but remember they are very small with much faster metabolism.   Some are saying that the nerves will never grow back or never establish function again.  The basis for this is looking at patients who have received kidney transplants they never get functional renervation of the kidney.  All of this is hopeful for the benefit of the procedure and there is tremendous enthusiasm for it.  We try to remain at least a little skeptical.  There will be a SIMPLICITY III trial in the US with 530 participants who will also be randomized.  What is pretty incredible is that the scientists behind it have shown all sorts of benefits in many different disease states but the common denominator might be increased sympathetic activity.  If you get rid of it so many other things improve.  It could be that when there are further studies and more careful medical treatment of these patients the benefit might not be what we thought it was.  The guidelines process is conservative by design， to determine what doctors really need to do to benefit a patient and what they really should not do.  In between there is room for judgment and room for innovation.  50 years from now I hope we don’t keep doing the same thing and having the same rules we have now.

　　Oparil教授：大鼠体内，只需要6周，虽然它们个子小，但新陈代谢非常快。有些人说神经绝不会重新生长或再次恢复功能。基于这种说法，接受肾脏移植的患者，其肾功能从未得到完全恢复。所有的研究都希望能优化手术治疗，并对之付诸无穷的热情。但我们至少尽量保持轻度怀疑。接下来将会在美国进行SIMPLICITY III试验 ，共有530例受试者接受随机治疗。但令人难以置信的是，科学家列举了肾脏去神经治疗对许多疾病状态的疗效，其共同点可能是增加交感神经活性。倘若你摆脱这个困扰，许多其它事情都会获得改善。开展进一步研究或对这些患者采用更谨慎的药物治疗，其疗效可能并非我们所期望的。该研究的设计是保守的，医生必须明确哪些患者可能受益而哪些患者是不可以。其实在两者之间存在判断和创新的空间，我希望从现在起50年内，不再重复同样的研究和标准。