Denervação Simpática Renal no tratamento da Hipertensão Arterial Não Controlada
Palavras-chave:
Denervação Simpática Renal, Hipertensão Arterial Refratária, Hipertensão Arterial Não Controlada, Agentes Anti-hipertensivos, Risco Cardiovascular, Revisão do Sistema Nervoso SimpáticoResumo
A hipertensão arterial não controlada (HANC) engloba pacientes com hipertensão arterial resistente e refratária, e está diretamente relacionada ao aumento da mortalidade, lesões em órgãos alvo, secundários a alterações renais graves, doenças cardíacas e cerebrovasculares, devido a falta de tratamento medicamentoso adequado ou não resposta às terapias farmacológicas e mudanças de estilo de vida. A mortalidade por doenças cardiovasculares aumenta progressiva e linearmente à medida que a pressão arterial (PA) aumenta, enquanto a redução da PA está associada à redução significativa dos riscos. O aumento do tônus simpático nas artérias renais é um dos principais componentes da HANC, e os cateteres para denervação simpática renal (DSR) têm sido desenvolvidos, utilizando diversas tecnologias que permitem a ablação das fibras nervosas no endotélio renal, por radiofrequência ou ultrassom, objetivando a redução da PA. As discussões e controvérsias sobre a eficácia deste tratamento são bastante amplas, principalmente quando associadas a resultados e evidências recentes. O presente artigo traz uma revisão sobre o papel do sistema nervoso simpático na HANC, explicação, desenvolvimento do conhecimento sobre a técnica percutânea de DSR e sua base de evidências.
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