Department of Internal Medicine II, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48,Salzburg, Austria.
J Am Coll Cardiol. 2012 Nov 6;60(19):1956-65. doi: 10.1016/j.jacc.2012.08.959. Epub 2012 Oct 10.
This study investigated the effect of catheter-based renal sympathetic denervation (RD) on central hemodynamics in patients with resistant hypertension.
High central blood pressure (BP) increases cardiovascular events and mortality independently of peripheral BP. The effect of RD on central BP is unclear.
A total of 110 patients underwent bilateral RD. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressure and hemodynamic indices at baseline and 1, 3, and 6 months after ablation. Ten patients with resistant hypertension not undergoing RD served as controls.
RD significantly reduced mean central aortic BP from 167/92 mm Hg to 149/88 mm Hg, 147/85 mm Hg, and 141/85 mm Hg at 1, 3, and 6 months (p < 0.001), respectively. Aortic pulse pressure decreased from 76.2 ± 23.3 mm Hg to 61.5 ± 17.5 mm Hg, 62.7 ± 18.1 mm Hg, and 54.5 ± 15.7 mm Hg 1, 3, and 6 months after RD (p < 0.001), respectively. Six months after RD aortic augmentation and augmentation index were significantly reduced by -11 mm Hg (p < 0.001) and -5.3% (p < 0.001), respectively. Carotid to femoral pulse wave velocity showed a significant reduction from 11.6 ± 3.2 m/s to 9.6 ± 3.1 m/s at 6 months (p < 0.001). Consistently, ejection duration and aortic systolic pressure load were significantly diminished, indicating improvement of cardiac work load by RD. No significant changes were obtained in control patients.
Besides the known effect of RD on brachial blood pressure, the study showed for the first time that this novel approach significantly improves arterial stiffness and central hemodynamics, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk.
本研究旨在探讨经导管肾交感神经去神经术（RD）对难治性高血压患者中心血液动力学的影响。
中心血压（BP）升高会增加心血管事件和死亡率，与外周 BP 无关。RD 对中心 BP 的影响尚不清楚。
共 110 例患者接受双侧 RD。采用桡动脉平板张力测量法和脉搏波分析，在基线和消融后 1、3 和 6 个月，得出中心主动脉压和血液动力学指标。10 例未接受 RD 的难治性高血压患者作为对照。
RD 可显著降低平均中心主动脉 BP，分别从 167/92mmHg 降至 149/88mmHg、147/85mmHg 和 141/85mmHg（p<0.001）。主动脉脉搏压从 76.2±23.3mmHg 降至 61.5±17.5mmHg、62.7±18.1mmHg 和 54.5±15.7mmHg（p<0.001），分别在 RD 后 1、3 和 6 个月。RD 后 6 个月，主动脉增强和增强指数分别显著降低 11mmHg（p<0.001）和 5.3%（p<0.001）。颈动脉-股动脉脉搏波速度从 11.6±3.2m/s 显著降至 9.6±3.1m/s（p<0.001），在 6 个月时。同样，射血时间和主动脉收缩压负荷明显减少，表明 RD 改善了心脏工作量。在对照组患者中未观察到明显变化。
除了 RD 对肱动脉血压的已知影响外，本研究首次表明，这种新方法可显著改善动脉僵硬度和中心血液动力学，这可能对心血管风险高的难治性高血压患者具有重要的预后意义。
