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Srce i krvni sudovi
2012, vol. 31, br. 1, str. 12-19
jezik rada: srpski
vrsta rada: prikaz slučaja
doi:10.5937/siks1201012B
Renalna denervacija u bolesnika sa rezistentom hipertenzijom - prikaz slučaja
Institut za kardiovaskularne bolesti, Dedinje + Univerziteta u Beogradu, Medicinski fakultet, Beograd

e-adresa: boskovics@hotmail.com

Sažetak

Rezistentna hipertenzija definisana kao vrednosti krvnog pritska ≥140/90 mmHg i pored terapije sa ≥3 antihipertenzivna leka u maksimalnim tolerabilnim dozama se javlja u 10-30 % svih osoba sa hipertenzijom (HTA). Osobe sa rezistentnom HTA imaju značajno povećan rizik od kardiovaskularnih i bubrežnih komplikacija. Iako je patofiziologija ovog oboljenja multifaktorijalna, u poslednje vreme fokus je na pojačanoj aktivnosti simpatičkog nervnog sistema. Studije torakolumbalne simpatektomije rađene 50-ih godina prošlog veka, animalni modeli, kao i efikasnost lekova koji imaju centralno dejstvo na sipatičke ganglione dokaz su da se HTA može regulisati blokadom simpatičkog sistema. Renalna denervacija (RND) predstavlja perkutanu, interventnu, proceduru tokom koje se vrši ablacija spleta aferentnih i eferentnih simpatičkih vlakana koje se nalaze u adventiciji bubrežnih arterija. U do sada objavljenim studijama pokazana je sigurnost i efikasnost ove procedure. Periproceduralne komplikacije su minimalne, a dugoročno ne dolazi do pojave komplikacija vezanih za morfologiju bubrežnih arterija. Sa druge strane, ova procedura dovodi do značajnog smanjena krvnog pritiska, prosečno za 30/15 mmHg. Najnovija istraživanja ukazuju na mogućnost da RND može povoljno uticati na funkcionalni kapacitet, smanjenje hipertrofije leve komore, smanjenje insulinske rezistencije i bolju regulaciju dijabetesa, kao i na manji uticaj sleep apneje na HTA.

Ključne reči

Rezistentna hipertenzija; renalna denervacija

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