顽固性高血压患者的肾去神经支配：六个月的结果。
Renal denervation in patients with resistant hypertension: six-month results.
作者信息
Dores Hélder, de Sousa Almeida Manuel, de Araújo Gonçalves Pedro, Branco Patrícia, Gaspar Augusta, Sousa Henrique, Canha Gomes Angela, Andrade Maria João, Carvalho Maria Salomé, Campante Teles Rui, Raposo Luís, Mesquita Gabriel Henrique, Pereira Machado Francisco, Mendes Miguel
机构信息
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal.
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Lisboa, Portugal; Centro Cardiovascular, Hospital da Luz, Lisboa, Portugal.
出版信息
Rev Port Cardiol. 2014 Apr;33(4):197-204. doi: 10.1016/j.repc.2013.09.008. Epub 2014 Jan 25.
INTRODUCTION
Increased activation of the sympathetic nervous system plays a central role in the pathophysiology of hypertension (HTN). Catheter-based renal denervation (RDN) was recently developed for the treatment of resistant HTN.
AIM
To assess the safety and efficacy of RDN for blood pressure (BP) reduction at six months in patients with resistant HTN.
METHODS
In this prospective registry of patients with essential resistant HTN who underwent RDN between July 2011 and May 2013, the efficacy of RDN was defined as ≥ 10 mm Hg reduction in office systolic blood pressure (SBP) six months after the intervention.
RESULTS
In a resistant HTN outpatient clinic, 177 consecutive patients were evaluated, of whom 34 underwent RDN (age 62.7 ± 7.6 years; 50.0% male). There were no vascular complications, either at the access site or in the renal arteries. Of the 22 patients with complete six-month follow-up, the response rate was 81.8% (n=18). The mean office SBP reduction was 22 mm Hg (174 ± 23 vs. 152 ± 22 mm Hg; p<0.001) and 9 mm Hg in diastolic BP (89 ± 16 vs. 80 ± 11 mm Hg; p=0.006). The number of antihypertensive drugs (5.5 ± 1.0 vs. 4.6 ± 1.1; p=0.010) and pharmacological classes (5.4 ± 0.7 vs. 4.6 ± 1.1; p=0.009) also decreased significantly. Of the 24-hour ambulatory BP monitoring and echocardiographic parameters analyzed, there were significant reductions in diastolic load (45 ± 29 vs. 27 ± 26%; p=0.049) and in left ventricular mass index (174 ± 56 vs. 158 ± 60 g/m(2); p=0.014).
CONCLUSION
In this cohort of patients with resistant HTN, RDN was safe and effective, with a significant BP reduction at six-month follow-up.
引言
交感神经系统激活增强在高血压（HTN）的病理生理学中起核心作用。基于导管的肾去神经支配术（RDN）最近被开发用于治疗顽固性高血压。
目的
评估RDN对顽固性高血压患者6个月时降低血压（BP）的安全性和有效性。
方法
在这个对2011年7月至2013年5月间接受RDN的原发性顽固性高血压患者的前瞻性登记研究中，RDN的疗效被定义为干预后6个月诊室收缩压（SBP）降低≥10 mmHg。
结果
在一家顽固性高血压门诊诊所，对177例连续患者进行了评估，其中34例接受了RDN（年龄62.7±7.6岁；50.0%为男性）。在穿刺部位或肾动脉均未出现血管并发症。在22例完成6个月随访的患者中，有效率为81.8%（n = 18）。诊室SBP平均降低22 mmHg（174±23 vs. 152±22 mmHg；p<0.001），舒张压（DBP）降低9 mmHg（89±16 vs. 80±11 mmHg；p = 0.006）。抗高血压药物数量（5.5±1.0 vs. 4.6±1.1；p = 0.010）和药物种类（5.4±0.7 vs. 4.6±1.1；p = 0.009）也显著减少。在分析的24小时动态血压监测和超声心动图参数中，舒张期负荷（45±29 vs. 27±26%；p = 0.049）和左心室质量指数（174±56 vs. 158±60 g/m²；p = 0.014）有显著降低。
结论
在这个顽固性高血压患者队列中，RDN安全有效，6个月随访时血压显著降低。
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