From the Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (S.E., C.U., D.L., I.K., B.C., U.L., M.B., F.M.) and Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik (S.W.), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; and Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany (R.E.S.).
Hypertension. 2015 Jan;65(1):193-9. doi: 10.1161/HYPERTENSIONAHA.114.04336. Epub 2014 Oct 20.
Renal denervation can reduce blood pressure in certain patients with resistant hypertension. The effect in patients with isolated systolic hypertension (ISH, ≥140/<90 mm Hg) is unknown. This study investigated the effects of renal denervation in 126 patients divided into 63 patients with ISH and 63 patients with combined hypertension (CH, ≥140/≥90 mm Hg) defined as baseline office systolic blood pressure (SBP) ≥140 mm Hg despite treatment with ≥3 antihypertensive agents. Renal denervation significantly reduced office SBP and diastolic blood pressure (DBP) at 3, 6, and 12 months by 17/18/17 and 5/4/4 mm Hg in ISH and by 28/27/30 and 13/16/18 mm Hg in CH, respectively. The reduction in SBP and DBP in ISH was lower compared with patients with CH at all observed time points (P<0.05 for SBP/DBP intergroup comparison). The nonresponder rate (change in office SBP <10 mm Hg) after 6 months was 37% in ISH and 21% in CH (P<0.001). Mean 24-hour ambulatory SBP and DBP after 3, 6, and 12 months were significantly reduced by 10/13/15 and 6/6/9 mm Hg in CH, respectively. In patients with ISH the reduction in systolic ambulatory blood pressure was 4/8/7 mm Hg (P=0.032/P<0.001/P=0.009) and 3/4/2 mm Hg (P=0.08/P<0.001/P=0.130) in diastolic ambulatory blood pressure after 3, 6, and 12 months, respectively. The ambulatory blood pressure reduction was significantly lower after 3 and 12 months in SBP and after 12 months in ambulatory DBP, respectively. In conclusion, renal denervation reduces office and ambulatory blood pressure in patients with ISH. However, this reduction is less pronounced compared with patients with CH.
肾动脉去神经术可降低某些难治性高血压患者的血压。但对于单纯收缩期高血压（ISH，≥140/<90mmHg）患者的疗效尚不清楚。本研究对 126 例患者进行了观察，这些患者分为 ISH 组（63 例）和合并高血压组（CH，≥140/≥90mmHg，定义为基线诊室收缩压（SBP）≥140mmHg，尽管接受了≥3 种降压药物治疗）。肾动脉去神经术可显著降低 3、6 和 12 个月时的诊室 SBP 和舒张压（DBP），在 ISH 患者中分别降低 17/18/17mmHg 和 5/4/4mmHg，在 CH 患者中分别降低 28/27/30mmHg 和 13/16/18mmHg。与 CH 患者相比，在所有观察时间点，ISH 患者的 SBP 和 DBP 下降幅度均较低（SBP/DBP 组间比较，P<0.05）。6 个月时无反应率（诊室 SBP 下降<10mmHg）在 ISH 组为 37%，在 CH 组为 21%（P<0.001）。3、6 和 12 个月时，平均 24 小时动态 SBP 和 DBP 分别降低 10/13/15mmHg 和 6/6/9mmHg。在 ISH 患者中，动态 SBP 分别降低 4/8/7mmHg（P=0.032/P<0.001/P=0.009）和 3/4/2mmHg（P=0.08/P<0.001/P=0.130），动态 DBP 分别降低 3/4/2mmHg（P=0.08/P<0.001/P=0.130）。与 3 个月和 12 个月时的 SBP 相比，与 12 个月时的动态 DBP 相比，动态血压下降幅度均较低。结论：肾动脉去神经术可降低 ISH 患者的诊室血压和动态血压，但与 CH 患者相比，降低幅度较小。
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