肾脏神经消融术可降低高血压抵抗患者的增强指数。
Renal nerve ablation reduces augmentation index in patients with resistant hypertension.
机构信息
aNeurovascular Hypertension & Kidney Disease Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia bDepartment of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland cHeart Centre Alfred Hospital dDepartment of Epidemiology & Preventive Medicine eFaculty of Medicine, Nursing and Health Sciences and Department of Physiology, Monash University, Melbourne, Victoria, Australia fDepartment of Medicine and Cardiology, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota gMedtronic ARDIAN Inc., Mountain View, California, USA hUniversitätsklinikum des Saarlandes, Homburg/Saar, Germany.
出版信息
J Hypertens. 2013 Sep;31(9):1893-900. doi: 10.1097/HJH.0b013e3283622e58.
OBJECTIVE
Renal denervation (RDN) has been demonstrated to reduce muscle sympathetic nerve activity (MSNA) and blood pressure (BP) in patients with resistant hypertension. Whether alterations of arterial stiffness may contribute to BP-lowering effects of RDN is unknown.
METHODS
We measured office BP and arterial stiffness using fingertip tonometry-derived augmentation index (EndoPAT2000) at baseline and at 3-month follow-up in 50 consecutive patients with resistant hypertension. Forty patients received RDN and 10 patients served as controls. MSNA was obtained in 20 RDN and 10 non-RDN patients.
RESULTS
Baseline BP averaged 170/92 ± 19/15 mmHg (RDN) and 171/93 ± 14/8 mmHg (non-RDN) despite the use of 4.9 ± 1.9 and 4.4 ± 2.0 antihypertensive drugs, respectively. RDN significantly reduced SBP (170 ± 19 vs. 154 ± 25 mmHg; P < 0.001) and DBP (92 ± 15 vs. 84 ± 16 mmHg; P<0.001), augmentation index (30.6 ± 23.8 vs. 22.7 ± 22.4%; P=0.002), AI@75 corrected for heart rate (22.4 ± 21.6 vs. 14.4 ± 20.7; P=0.002) and MSNA (80 ± 15 vs. 71 ± 18 bursts/100 heartbeats; P<0.01). Changes in AI@75 with RDN were unrelated to SBP (r=0.043; P = 0.79), and DBP (r = 0.092; P = 0.57) and MSNA changes (r = -0.17; P = 0.49). No changes in BP, augmentation index, AI@75 or MSNA were observed in the non-RDN group.
CONCLUSION
RDN results in a substantial and rapid reduction in augmentation index, which appears to be independent of BP and MSNA changes. These findings are indicative of a beneficial effect of RDN on arterial stiffness in patients with resistant hypertension and may contribute to the sustained BP-lowering effect of RDN.
目的
肾去神经术（RDN）已被证明可降低抗药性高血压患者的肌肉交感神经活动（MSNA）和血压（BP）。动脉僵硬度的改变是否有助于 RDN 的降压效果尚不清楚。
方法
我们在 50 例连续抗药性高血压患者的基线和 3 个月随访时使用指尖张力测量法衍生的增强指数（EndoPAT2000）测量诊室血压和动脉僵硬度。40 例患者接受 RDN，10 例患者作为对照。20 例 RDN 患者和 10 例非 RDN 患者获得 MSNA。
结果
尽管分别使用了 4.9 ± 1.9 和 4.4 ± 2.0 种降压药物，基线 BP 平均为 170/92 ± 19/15 mmHg（RDN）和 171/93 ± 14/8 mmHg（非 RDN）。RDN 显著降低 SBP（170 ± 19 对 154 ± 25 mmHg；P < 0.001）和 DBP（92 ± 15 对 84 ± 16 mmHg；P < 0.001），增强指数（30.6 ± 23.8 对 22.7 ± 22.4%；P = 0.002），AI@75 校正心率（22.4 ± 21.6 对 14.4 ± 20.7；P = 0.002）和 MSNA（80 ± 15 对 71 ± 18 次/100 次心跳；P < 0.01）。RDN 对 AI@75 的影响与 SBP（r = 0.043；P = 0.79）和 DBP（r = 0.092；P = 0.57）和 MSNA 变化（r = 0.17；P = 0.49）无关。非 RDN 组的 BP、增强指数、AI@75 或 MSNA 无变化。
结论
RDN 可显著迅速降低增强指数，这似乎与 BP 和 MSNA 变化无关。这些发现表明 RDN 对抗药性高血压患者的动脉僵硬度有有益的影响，并可能有助于 RDN 的持续降压作用。
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