Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Am J Hypertens. 2013 Dec;26(12):1452-8. doi: 10.1093/ajh/hpt132. Epub 2013 Aug 9.
Studies of endovascular renal denervation (RDN) have demonstrated significant blood pressure reduction in eligible patients with resistant hypertension. These trials have used stringent inclusion and exclusion criteria in patient enrollment, potentially selecting for a small subset of patients with resistant hypertension. In this study, we examined the changes in estimated prevalence of resistant hypertension when using increasingly stringent definitions of resistant hypertension in a fixed population and assessed the generalizability of RDN when applying study criteria to a community-based hypertensive population.
A retrospective chart review was done of hypertensive outpatients. Four increasingly stringent interpretations of the American Heart Association definition of resistant hypertension were used to calculate prevalence estimates. Patients eligible for RDN were identified using criteria from SYMPLICITY HTN-3. Demographic and clinical characteristics were compared.
We identified 1,756 hypertensive outpatients; 55.0% were male, 53.9% were white, and subjects had a mean age of 66.6 ± 12.5 years and a body mass index (BMI) of 30.1 ± 10.7 kg/m(2). Only 14 (0.8%) were eligible for RDN. Among these patients, 10 (71.4%) were female and all were black, with a mean age of 69.9 ± 8.8 and BMI of 35.7 ± 6.6. Congestive heart failure was more common in patients eligible for RDN.
Patients eligible for RDN based on published studies represent an exceedingly small proportion of the total hypertensive population. Further studies are necessary to determine if the benefits of RDN can be generalized to a broader range of hypertensive patients than those included in previous trials.
血管内肾去神经术（RDN）的研究表明，在符合条件的难治性高血压患者中，血压显著降低。这些试验在患者入组时使用了严格的纳入和排除标准，可能选择了一小部分难治性高血压患者。在这项研究中，我们检查了在固定人群中使用越来越严格的难治性高血压定义时，难治性高血压的估计患病率的变化，并评估了将研究标准应用于基于社区的高血压人群时 RDN 的普遍性。
对高血压门诊患者进行回顾性图表审查。使用美国心脏协会对难治性高血压的定义的四种越来越严格的解释来计算患病率估计。使用 SYMPLICITY HTN-3 的标准来确定有资格进行 RDN 的患者。比较人口统计学和临床特征。
我们确定了 1756 名高血压门诊患者；55.0%为男性，53.9%为白人，患者的平均年龄为 66.6±12.5 岁，体重指数（BMI）为 30.1±10.7kg/m2。只有 14 名患者（0.8%）有资格进行 RDN。在这些患者中，10 名（71.4%）为女性，全部为黑人，平均年龄为 69.9±8.8 岁，BMI 为 35.7±6.6。充血性心力衰竭在有资格进行 RDN 的患者中更为常见。
根据已发表的研究，有资格进行 RDN 的患者仅占高血压总人群的极小比例。需要进一步研究以确定 RDN 的益处是否可以推广到比以前的试验中纳入的患者范围更广的高血压患者。
