Murray D. Esler教授  Baker IDI Heart&Diabetes Institute  

　　<International Circulation>: In addition to hypertension，activation of the sympathetic nervous system results in atherosclerosis， heart failure， kidney failure， etc. Are there additional benefits， aside from lowering blood pressure， to renal denervation?

　　Prof. Esler: There are a couple of proven benefits of inhibiting the sympathetic nervous system from renal denervation. One is a clear positive effect in diabetes and insulin resistance. That works by the reduction in sympathetic tone to skeletal muscle increase blood flow to and glucose uptake in skeletal muscle， which is a major factor in insulin resistance. That has been shown in clinical data. Renal denervation is about a s powerful as the most commonly used drug， metformin. That is one benefit. The second is that we have found with RDN in HT that reversal of left ventricular hypertrophy occurs readily， faster， and to a greater degree than you would expect from the blood pressure reduction. That is because sympathies tone effects cardiacmyocyte growth and ventricular hypertrophy. Those are two benefits.

　　《国际循环》：除高血压外，交感神经系统激活还能导致动脉粥样硬化、心力衰竭、肾脏衰竭等。除降低血压外，肾脏去神经治疗是否还具有其他额外的益处？

　　Esler教授：目前已证实，通过肾脏去神经治疗抑制交感神经系统能为患者带来很多获益。其一是对糖尿病及胰岛素抵抗具有积极的作用。这主要是通过降低支配骨骼肌的交感神经张力来增加血流量及骨骼肌内葡萄糖的吸收来实现的。临床数据已证实，葡萄糖的吸收是胰岛素抵抗的重要影响因素。肾脏去神经治疗的降糖疗效与最常用降糖药物二甲双胍一样强大。这是一个获益。另一个获益就是我们发现，RDN能更容易、更快地逆转高血压患者的左室肥厚，并且其效果要不降压治疗的预期效果要更好。这是因为交感神经张力可以影响心肌细胞的生长及心室肥厚。这就是肾脏去神经治疗的两个额外获益。

　　<International Circulation>：Do you think that the indications for RDN will be expanded given these additional benefits?

　　Prof. Esler: I think the indication will be expanded. It is drawing a long bow to suggest that we will treat diabetes with RDN， but clearly there is drift towards wider application of the method. Renal HT， which is not an approved indication， has a pile of data indicating that there is good bpreduction. The trial work in HF， where the sympathetic nervous outflow to the kidneys is activated， is clearly adverse. I would expect in years to come that the indications would be expanded to treatment of renal HT and HF at least.

　　《国际循环》：鉴于其具有这些额外获益，您是否认为应拓展RDN的适应证？

　　Esler教授：我认为应该放宽其适应证。虽然应用RDN来治疗糖尿病还有很长的路要走，但很明确的是该方法必将被广泛应用。虽然目前肾性高血压还不是RDN的适应证，但大量数据提示，RDN具有良好的降压疗效。心力衰竭时，肾脏交感神经被激活对机体产生不利影响，在心力衰竭中开展的试验同样发现了疗效。我希望未来几年内RDN的适应证能够被放宽，至少可以用于治疗肾性高血压和心力衰竭。

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