外科治疗高血压研究进展

doi:10.3760/cma.j.cn441417-20240904-03012

摘要/Abstract

摘要：

高血压是一种常见慢性病，多采用内科药物管理，但部分特定情况下，可能需要外科干预。随着医疗技术创新进步，高血压外科治疗取得进展，为患者提供新的治疗选择。高血压外科治疗主要包括传统方法、减重代谢手术、跨学科治疗和微血管减压术。高血压外科治疗旨在解决具体病因，迅速控制病情，挽救患者生命。

关键词:

外科治疗, 高血压, 适应证, 进展

Abstract:

Hypertension is a common chronic condition that is usually managed with medical medications. However, in some specific cases, surgical intervention may be required. In recent years, with advances and innovations in medical technology, significant progress has been made in the surgical management of hypertension, providing new treatment options for many patients. The main surgical treatments for hypertension include traditional methods, weight loss metabolic surgery, interdisciplinary treatment, and microvascular decompression. In different situations, surgical interventions for hypertension aim to address the specific cause of the disease, rapidly control the condition, and potentially save the patients' life.

Key words:

Surgical treatment, Hypertension, Indications, Progress

曾令果赵洲刘为朋胡宝光.

外科治疗高血压研究进展 [J]. 国际医药卫生导报, 2025, 31(3): 411-415.

Zeng Lingguo, Zhao Zhou, Liu Weipeng, Hu Baoguang.

Research progress in the field of surgical treatment for hypertension [J]. International Medicine and Health Guidance News, 2025, 31(3): 411-415.

参考文献

[1] Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension[J]. Eur Heart J, 2018, 39(33):3021-3104. DOI: 10.1093/eurheartj/ehy339.
[2] Dogra P, Bancos I, Young WF. Primary aldosteronism: a pragmatic approach to diagnosis and management[J]. Mayo Clin Proc, 2023, 98(8):1207-1215. DOI: 10.1016/j.mayocp.2023.04.023.
[3] Alexandraki KI, Markou A, Papanastasiou L, et al. Surgical treatment outcome of primary aldosteronism assessed using new modified diagnostic tests[J]. Hormones (Athens), 2021, 20(2):359-368. DOI: 10.1007/s42000- 021-00280-8.
[4] Hiremath S, Sapir-Pichhadze R, Nakhla M, et al. Hypertension Canada's 2020 evidence review and guidelines for the management of resistant hypertension[J]. Can J Cardiol, 2020, 36(5):625-634. DOI: 10.1016/j.cjca.2020.02.083.
[5] Saadi A, Bedoui MA, Zaghbib S, et al. Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism[J]. Front Endocrinol (Lausanne), 2023, 14:1205988. DOI: 10.3389/fendo.2023.1205988.
[6] Pilz S, Kocjan T, Theiler-Schwetz V, et al. Primary aldosteronism 2.0: an update for clinicians on diagnosis and treatment[J]. Pol Arch Intern Med, 2023, 133(10):16585. DOI: 10.20452/pamw.16585.
[7] Wachtel H, Fraker DL. Therapeutic outcomes with surgical and medical management of primary aldosteronism[J]. Curr Cardiol Rep, 2021, 23(7):89. DOI: 10.1007/s11886-021-01516-0.
[8] Mullen N, Curneen J, Donlon PT, et al. Treating primary aldosteronism-induced hypertension: novel approaches and future outlooks[J]. Endocr Rev, 2024, 45(1):125-170. DOI: 10.1210/endrev/bnad026.
[9] Miyamoto S, Yoshida Y, Ozeki Y, et al. Pitfalls in the diagnosis and treatment of a hypertensive patient with unilateral primary aldosteronism and contralateral pheochromocytoma: a case report[J]. BMC Endocr Disord, 2023, 23(1):44. DOI: 10.1186/s12902-023-01297-3.
[10] Scott T, Venuthurupalli SK. Kidney autotransplantation as a treatment for resistant hypertension due to renal artery stenosis: a case report and review of the literature[J]. Clin Nephrol Case Stud, 2022, 10:1-5. DOI: 10.5414/CNCS110565.
[11] Arias A, Rodríguez-Álvarez C, González-Dávila E, et al. Arterial hypertension in morbid obesity after bariatric surgery: five years of follow-up, a before-and-after study[J]. Int J Environ Res Public Health, 2022, 19(3):1575. DOI: 10.3390/ijerph19031575.
[12] Hall ME, Cohen JB, Ard JD, et al. Weight-loss strategies for prevention and treatment of hypertension: a scientific statement from the American Heart Association[J]. Hypertension, 2021, 78(5):e38-e50. DOI: 10.1161/HYP.0000000000000202.
[13] Pareek M, Schauer PR, Kaplan LM, et al. Metabolic surgery: weight loss, diabetes, and beyond[J]. J Am Coll Cardiol, 2018, 71(6):670-687. DOI: 10.1016/j.jacc.2017. 12.014.
[14] Lauder L, Mahfoud F, Azizi M, et al. Hypertension management in patients with cardiovascular comorbidities[J]. Eur Heart J, 2023, 44(23):2066-2077. DOI: 10.1093/eurheartj/ehac395.
[15] Sergesketter AR, Geng Y, Shammas RL, et al. The association between metabolic derangement and wound complications in elective plastic surgery[J]. J Surg Res, 2022, 278:39-48. DOI: 10.1016/j.jss.2022.03.017.
[16] Kim S, Kim MJ, Jeon J, et al. Effects of percutaneous angioplasty on kidney function and blood pressure in patients with atherosclerotic renal artery stenosis[J]. Kidney Res Clin Pract, 2019, 38(3):336-346. DOI: 10.23876/j.krcp.18.0148.
[17] Gornik HL, Persu A, Adlam D, et al. First International Consensus on the diagnosis and management of fibromuscular dysplasia[J]. Vasc Med, 2019, 24(2):164-189. DOI: 10.1177/1358863X18821816.
[18] Rosławiecka A, Kabłak-Ziembicka A, Badacz R, et al. Long-term outcomes and determinants of stenosis recurrence after renal artery angioplasty in hypertensive patients with renovascular disease[J]. Postepy Kardiol Interwencyjnej, 2020, 16(1):65-75. DOI: 10.5114/aic.2019.91309.
[19] de Oliveira Campos JL, Bitencourt L, Pedrosa AL, et al. Renovascular hypertension in pediatric patients: update on diagnosis and management[J]. Pediatr Nephrol, 2021, 36(12):3853-3868. DOI: 10.1007/s00467-021-05063-2.
[20] Souza KP, Falsarella PM, Nasser F, et al. Spontaneous renal artery dissection: angioplasty with stent implantation in one-year follow-up[J]. Einstein (Sao Paulo), 2022, 20:eRC6570. DOI: 10.31744/einstein_journal/2022RC6570.
[21] Ben Hammamia M, Brahem Myriam T, Mrad Malek B, et al. Percutaneous angioplasty of renal artery stenosis: short- and long-term results[J]. J Med Vasc, 2019, 44(6):374-379. DOI: 10.1016/j.jdmv.2019.09.006.
[22] Hasjim BJ, Fujitani RM, Chen SL, et al. Utilization of carbon dioxide angiography and percutaneous balloon angioplasty for treatment of transplant renal artery stenosis[J]. Ann Vasc Surg, 2020, 65:10-16. DOI: 10.1016/j.avsg.2019.11.009.
[23] Gunawardena T, Sharma H, Elmghrbee A, et al. Endovascular treatment for transplant renal artery stenosis improves the short- and long-term graft and patient outcomes[J]. Exp Clin Transplant, 2022, 20(3):253-257. DOI: 10.6002/ect.2021.0476.
[24] Montali F, Panarese A, Binda B, et al. Transplant renal artery stenosis: a case report of functional recovery six months after angioplasty[J]. Transplant Proc, 2021, 53(4):1272-1274. DOI: 10.1016/j.transproceed.2021.03.019.
[25] Lu YT, Zhou ZM, Zhang D, et al. Percutaneous transluminal renal angioplasty for fibromuscular dysplasia and prognostic risk factors: a retrospective Chinese cohort study[J]. J Clin Med, 2022, 12(1):23. DOI: 10.3390/jcm12010023.
[26] Chen Y, Pan H, Luo G, et al. Use of percutaneous transluminal renal angioplasty in atherosclerotic renal artery stenosis: a systematic review and meta-analysis[J]. J Int Med Res, 2021, 49(1):300060520983585. DOI: 10.1177/0300060520983585.
[27] Farahani RA, Afarideh M, Zhu XY, et al. Percutaneous transluminal renal angioplasty attenuates poststenotic kidney mitochondrial damage in pigs with renal artery stenosis and metabolic syndrome[J]. J Cell Physiol, 2021, 236(5):4036-4049. DOI: 10.1002/jcp.30146.
[28] Wang Q, Li X, Liu Z, et al. Diagnosis and treatment of renal artery stenosis in China in the era of donation after cardiac death[J]. Ann Transplant, 2020, 25:e918076. DOI: 10.12659/AOT.918076.
[29] Merla S, Simoni R, Tedeschi S, et al. High renin hypertension in focal renal fibromuscular dysplasia: turn off of renin system angiotensin overactivation by renal angioplasty cured high blood pressure and quickly reversed myocardial hypertrophy[J]. Acta Biomed, 2021, 92(S1):e2021162. DOI: 10.23750/abm.v92iS1.9358.
[30] Sarafidis PA, Theodorakopoulou M, Ortiz A, et al. Atherosclerotic renovascular disease: a clinical practice document by the European Renal Best Practice (ERBP) board of the European Renal Association (ERA) and the Working Group Hypertension and the Kidney of the European Society of Hypertension (ESH)[J]. Nephrol Dial Transplant, 2023, 38(12):2835-2850. DOI: 10.1093/ndt/gfad095.
[31] Coleman DM, Eliason JL, Beaulieu R, et al. Surgical management of pediatric renin-mediated hypertension secondary to renal artery occlusive disease and abdominal aortic coarctation[J]. J Vasc Surg, 2020, 72(6):2035-2046.e1. DOI: 10.1016/j.jvs.2020.02.045.
[32] Vijayvergiya R, Kasinadhuni G, Bootla D, et al. Intravascular ultrasound-supported percutaneous angioplasty of post-kidney transplant renal artery bifurcation stenosis[J]. Vascular, 2022, 30(1):167-170. DOI: 10.1177/17085381211001176.
[33] Hebert CA, Rosenthal RL, Schussler JM. Transradial renal angioplasty and stent placement for systemic hypertension caused by severe unilateral renovascular stenosis[J]. Cureus, 2023, 15(2):e34781. DOI: 10.7759/cureus.34781.
[34] Ahmed S, Hundemer GL. Benefits of surgical over medical treatment for unilateral primary aldosteronism[J]. Front Endocrinol (Lausanne), 2022, 13:861581. DOI: 10.3389/fendo.2022.861581.
[35] Sasaki Y, Mishima E, Kikuchi K, et al. Treatment of refractory hypertension with timely angioplasty in total renal artery occlusion with atrophic kidney[J]. Intern Med, 2021, 60(2):287-292. DOI: 10.2169/internalmedicine.5290-20.
[36] Rommel KP, Pagoulatou S, Kresoja KP, et al. Modulation of pulsatile left ventricular afterload by renal denervation in heart failure with preserved ejection fraction[J]. Circ Heart Fail, 2023, 16(10):e010543. DOI: 10.1161/CIRCHEARTFAILURE.123.010543.
[37] Hikita H, Kojima K, Kimura S, et al. Impact of renal artery stent implantation on hypertension in patients with hemodialysis[J]. Int J Angiol, 2014, 23(2):107-110. DOI: 10.1055/s-0034-1372247.
[38] Lauder L, Böhm M, Mahfoud F. The current status of renal denervation for the treatment of arterial hypertension[J]. Prog Cardiovasc Dis, 2021, 65:76-83. DOI: 10.1016/j.pcad.2021.02.005.
[39] Jelaković B, Perkov D, Barišić K, et al. Renal denervation in the treatment of resistant hypertension and difficult-to-control hypertension - Consensus Document of the Croatian Hypertension League - Croatian Society of Hypertension, Croatian Cardiac Society, Croatian Endovascular Initiative, Croatian Society for Diabetes and Metabolic Diseases, Croatian Renal Association, and Croatian Society of Family Physicians of the Croatian Medical Association[J]. Vasc Health Risk Manag, 2023, 19:805-826. DOI: 10.2147/VHRM.S422773.
[40] Gupta A, Prince M, Bob-Manuel T, et al. Renal denervation: alternative treatment options for hypertension?[J]. Prog Cardiovasc Dis, 2020, 63(1):51-57. DOI: 10.1016/j.pcad.2019.12.007.
[41] Kandzari DE, Townsend RR, Kario K, et al. Safety and efficacy of renal denervation in patients taking antihypertensive medications[J]. J Am Coll Cardiol, 2023, 82(19):1809-1823. DOI: 10.1016/j.jacc.2023.08.045.
[42] Chen C, Zhang Y, Yin D, et al. Refractory hypertension secondary to renal artery stenosis with a honeycomb-like structure[J]. BMC Cardiovasc Disord, 2021, 21(1):606. DOI: 10.1186/s12872-021-02428-1.
[43] Lateef N, Virk HU, Khan MS, et al. Role of renal sympathetic denervation in hypertension[J]. Future Cardiol, 2020, 16(4):211-216. DOI: 10.2217/fca-2019- 0034.
[44] Masuda T, Hata M, Yamaya K, et al. Two cases of endovascular repair with the stent graft for retrograde type A acute aortic dissection with complications[J]. Ann Thorac Cardiovasc Surg, 2019, 25(5):278-282. DOI: 10.5761/atcs.cr.17-00200.
[45] Kim SS, Stein DR, Ferguson MA, et al. Surgical management of pediatric renovascular hypertension and midaortic syndrome at a single-center multidisciplinary program[J]. J Vasc Surg, 2021, 74(1):79-89.e2. DOI: 10.1016/j.jvs.2020.12.053.
[46] Lu W, Wang H, Yan Z, et al. Microvascular decompression for the treatment of neurogenic hypertension with trigeminal neuralgia[J]. BMC Neurol, 2019, 19(1):341. DOI: 10.1186/s12883-019-1569-y.
[47] Escobar Arregocés FM, Del Hierro Rada M, Sáenz Martinez MJ, et al. Systemic inflammatory response to non-surgical treatment in hypertensive patients with periodontal infection[J]. Medicine (Baltimore), 2021, 100(13):e24951. DOI: 10.1097/MD.0000000000024951.