From the Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia (D.H., P.M., E.A.L., G.W.L., M.D.E., M.P.S.); Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland (D.H., K.N.); Heart Centre Alfred Hospital, Melbourne, Australia (A.S.W., H.K., M.D.E., M.P.S.); and Department of Physiology, Faculty of Medicine, Nursing and Health Sciences (E.A.L., G.W.L., M.P.S.) and Department of Epidemiology and Preventive Medicine (H.K.), Monash University, Melbourne, Australia.
Hypertension. 2014 Jul;64(1):118-24. doi: 10.1161/HYPERTENSIONAHA.113.03098. Epub 2014 Apr 14.
Renal denervation (RDN) reduces muscle sympathetic nerve activity (MSNA) and blood pressure (BP) in resistant hypertension. Although a persistent BP-lowering effect has been demonstrated, the long-term effect on MSNA remains elusive. We investigated whether RDN influences MSNA over time. Office BP and MSNA were obtained at baseline, 3, 6, and 12 months after RDN in 35 patients with resistant hypertension. Office BP averaged 166±22/88±19 mm Hg, despite the use of an average of 4.8±2.1 antihypertensive drugs. Baseline MSNA was 51±11 bursts/min ≈2- to 3-fold higher than the level observed in healthy controls. Mean office systolic and diastolic BP significantly decreased by -12.6±18.3/-6.5±9.2, -16.1±25.6/-8.6±12.9, and -21.2±29.1/-11.1±12.9 mm Hg (P<0.001 for both systolic BP and diastolic BP) with RDN at 3-, 6-, and 12-month follow-up, respectively. MSNA was reduced by -8±12, -6±12, and -6±11 bursts/min (P<0.01) at 3-, 6-, and 12-month follow-up. The reduction in MSNA was maintained, despite a progressive fall in BP over time. No such changes were observed in 7 control subjects at 6-month follow-up. These findings confirm previous reports on the favorable effects of RDN on elevated BP and demonstrate sustained reduction of central sympathetic outflow ≤1-year follow-up in patients with resistant hypertension and high baseline MSNA. These observations are compatible with the hypothesis of a substantial contribution of afferent renal nerve signaling to increased BP in resistant hypertension and argue against a relevant reinnervation at 1 year after procedure.
肾去神经术（RDN）可降低抵抗性高血压患者的肌肉交感神经活性（MSNA）和血压（BP）。尽管已经证明了持续的降压作用，但 MSNA 的长期影响仍不清楚。我们研究了 RDN 是否会随时间影响 MSNA。在 35 名抵抗性高血压患者中，在 RDN 后 3、6 和 12 个月分别进行了诊室血压和 MSNA 的检测。尽管使用了平均 4.8±2.1 种降压药物，但诊室血压平均为 166±22/88±19mmHg。基线 MSNA 为 51±11 次/分钟，大约是健康对照组的 2-3 倍。平均诊室收缩压和舒张压分别显著降低-12.6±18.3/-6.5±9.2、-16.1±25.6/-8.6±12.9 和-21.2±29.1/-11.1±12.9mmHg（P<0.001，均为收缩压和舒张压），分别在 RDN 后 3、6 和 12 个月随访时。MSNA 分别降低了-8±12、-6±12 和-6±11 次/分钟（P<0.01），分别在 3、6 和 12 个月随访时。尽管随着时间的推移血压逐渐下降，但 MSNA 的降低仍保持不变。在 7 名对照受试者的 6 个月随访中未观察到这种变化。这些发现证实了之前关于 RDN 对升高的 BP 有利影响的报告，并证明了在基线 MSNA 较高的抵抗性高血压患者中，1 年随访时中枢交感神经输出持续降低。这些观察结果与传入肾神经信号对抵抗性高血压中升高的 BP 有实质性贡献的假设一致，并反对在手术后 1 年内有相关再支配的观点。
