Rosenbaum D, Villeneuve F, Gury C, Girerd X
Unité de prévention cardiovasculaire, pôle cœur métabolisme, hôpital de La Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Ann Cardiol Angeiol (Paris). 2012 Jun;61(3):229-33. doi: 10.1016/j.ancard.2012.04.018. Epub 2012 May 15.
To evaluate in hypertensive patients followed in a specialized hypertension unit, the prevalence of subjects uncontrolled despite triple therapy including a diuretic. The aim is to estimate the percentage of hypertensive patients with an indication to renal denervation.
From a database of computerized medical records of a unit specialized in hypertension, it was extracted 144 consecutive cases of subjects treated and followed for at least 1year and having had a home pressure monitoring (HPM) on treatment, and if necessary a work-up for a secondary hypertension. The blood pressure (BP) was evaluated in office by automated method (after 2 and 8minutes) and with HPM (average of three measurements in the morning and evening for three consecutive days).
The population has the following characteristics: age 62 with 26% over 70years, treated dyslipidemia (39%), treated diabetes (11%), adrenal hypertension treated medically (14%), severe renal failure (3%). The means of treatment are: a monotherapy (33%), bitherapy (35%), triple therapy (17%), quadritherapy (7%), pentatherapy or more (1%), spironolactone (45%), thiazide diuretics (49%). The uncontrolled hypertension was observed in 26% if the BP is evaluated with HPM, in 52% if the BP is evaluated at the office after 2minutes of rest and 7% if the BP is evaluated after 8minutes of rest (P<0.01). In patients treated with at least a tritherapy in association with a diuretic, an uncontrolled hypertension was observed in 5% if the BP is evaluated with HPM. Failure to control for the SBP is the cause of 80% of resistant hypertension.
The frequency of resistant hypertension is 5% of hypertensive patients followed in a specialized hypertension unit when guidelines are applied in the case of uncontrolled hypertension. These results indicate that the indication for renal denervation affects only a small percentage of patients treated for hypertension.
在一家专门的高血压治疗单位对高血压患者进行评估，确定尽管接受了包括利尿剂在内的三联疗法但血压仍未得到控制的患者比例。目的是估计有肾去神经支配指征的高血压患者的百分比。
从一个高血压专科单位的计算机化医疗记录数据库中，提取了144例连续接受治疗并随访至少1年且在治疗期间进行了家庭血压监测（HPM）的患者病例，必要时还对继发性高血压进行了检查。通过自动方法（在休息2分钟和8分钟后）在诊室评估血压，并通过HPM（连续三天早晚各测量三次的平均值）评估血压。
该人群具有以下特征：年龄62岁，70岁以上者占26%，接受治疗的血脂异常患者（39%），接受治疗的糖尿病患者（11%），接受药物治疗的肾上腺性高血压患者（14%），严重肾衰竭患者（3%）。治疗方法的比例为：单一疗法（33%），联合疗法（35%），三联疗法（17%），四联疗法（7%），五联疗法或更多（1%），螺内酯（45%），噻嗪类利尿剂（49%）。如果通过HPM评估血压，26%的患者高血压未得到控制；如果在休息2分钟后在诊室评估血压，52%的患者高血压未得到控制；如果在休息8分钟后评估血压，7%的患者高血压未得到控制（P<0.01）。在至少接受三联疗法联合利尿剂治疗的患者中，如果通过HPM评估血压，5%的患者高血压未得到控制。收缩压未得到控制是80%顽固性高血压的原因。
当在高血压未得到控制的情况下应用指南时，在一家专门的高血压治疗单位随访的高血压患者中，顽固性高血压的发生率为5%。这些结果表明，肾去神经支配的指征仅影响一小部分接受高血压治疗的患者。
