<International Circulation>: Will RDN get better results in patients with highly active sympathetic nervous systems， such as young patients or patients with increased heart rate?

　　Prof. Esler: I think it is a given that this technique will work best in patients with the highest level of sympatheticactivation. Identifyingthem is the problem. The clinical tests available are not very precise measures， but you can talk about clinical groups who have high sympathetic tone. One of them is milder grades of HT. It could well be that thistechnique will work well in mild ht and treatment of mild ht might be seen in the future. There are public health physicians now that say this will become standard care for all ht. they might even do it first， with medication added on top.

　　《国际循环》：RDN对年轻患者或心率加快的交感神经高度激活患者中是否疗效更好？

　　Esler教授：我认为这项技术在交感神经高度激活的患者中肯定疗效会更好。但难题是如何识别这些患者。虽然目前可用的临床检测方法并不精确，但我们还是能够知道哪些患者的交感神经张力较高。其中一种方法就是高血压分级较轻的患者。RDN在轻度高血压患者中具有良好的疗效，未来有望被用于治疗轻度高血压。现在已经有公卫医生提出RDN将成为所有高血压患者的标准治疗方法。在进行药物治疗前，他们甚至会首先选用RDN。

　　<International Circulation>: What are opinions on using RDN as prophylactic measure for HT?

　　Prof. Esler: It can be prevented from happening initially. It would certainly have to be proved safe in the long term. This is crystal ball gazing at this point. It is a wide open field and the limits are not clear at the moment.

　　《国际循环》：您对应用RDN进行高血压的预防有何看法？

　　Esler教授：它能够预防高血压的发生，从长远来看还具有良好的安全性。但这只是一种预测。RDN预防高血压是一个开放的领域，目前还有很多局限性尚不得知。

　　<International Circulation>: Some people do not respond to RDN， can you comment on why that may be?

　　Prof. Esler: The failure-to-respond rate is around 15% and that is disappointing， given the inconvenience and cost to the patient. We only have possible ideas of why that happens. One possibility is that the HT in these patients is not driven by the sympathetic nervous system and we wonder whether the level ofsympathetic activation determines how well it works. The second is that the interventionalist may have had a bad day and did not perform the procedure well. It could also be that the devices-and there are several on the market now-are not perfect. There needs to be furtherengineering and product development. Sometimes they do not reach the nerves. The nerves are close to artery lumen but they are a little removed in some places. We never know for sure.

　　《国际循环》：有些人对RDN无反应，您认为其可能的原因是什么？

　　Esler教授：令人失望的是RDN无反应率为15%左右，给患者带来很大的不便，并增加其治疗成本。我们目前只能推测其可能的原因。一种可能性是，这些患者的高血压并不是有交感神经激活所导致的。我们不知道交感神经激活的水平是否决定了RDN治疗的疗效。第二种可能性是干预的实施者没有很好的完成手术操作。还有可能是目前已经上市的几种装置还不是太完善，需要进一步的产品研发。有时，它们并未到达神经。虽然神经靠近动脉管腔，但在某些位置它们可能与动脉管腔还是有一点距离的。我们永远不能肯定地知道它们的具体位置。