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经皮双极射频球囊导管肾去神经术治疗顽固性高血压患者:REDUCE-HTN临床研究的6个月结果

Renal denervation with a percutaneous bipolar radiofrequency balloon catheter in patients with resistant hypertension: 6-month results from the REDUCE-HTN clinical study.

作者信息

Sievert Horst, Schofer Joachim, Ormiston John, Hoppe Uta C, Meredith Ian T, Walters Darren L, Azizi Michel, Diaz-Cartelle Juan, Cohen-Mazor Meital

机构信息

CardioVascular Center Frankfurt CVC, Frankfurt, Germany.

出版信息

EuroIntervention. 2015 Feb;10(10):1213-20. doi: 10.4244/EIJY14M12_01.

Abstract

AIMS

To evaluate the safety and efficacy of the balloon-based bipolar Vessix Renal Denervation System in treating patients with resistant hypertension.

METHODS AND RESULTS

In this prospective, multicentre, single-arm study, 146 patients (age 58.6±10.5 years; 61% men) with office systolic blood pressure (BP) ≥160 mmHg despite ≥3 antihypertensive medications at maximally tolerated doses were treated with the Vessix System. Efficacy endpoints were reductions in office and 24-hour ambulatory systolic and diastolic BPs at six months. Acute and long-term safety, with a focus on the renal artery and estimated glomerular filtration rate (eGFR), were assessed. Baseline office and ambulatory BPs were 182.4±18.4/100.2±14.0 mmHg and 153.0±15.1/87.5±13.2 mmHg, respectively. No acute renal artery injury requiring intervention or serious periprocedural cardiovascular events occurred. At six months, office BP was reduced by 24.7±22.1/10.3±12.7 mmHg (p<0.0001) and ambulatory BP was reduced by 8.4±14.4/5.9±9.1 mmHg (N=69; p<0.0001). Twenty-six patients (18%) achieved an office systolic BP <140 mmHg. One patient had renal artery stenosis which required stenting. Mean eGFR remained stable.

CONCLUSIONS

Renal artery denervation with the Vessix System reduced both office and ambulatory BP at six months in patients with resistant hypertension. Renal artery safety and renal function results are favourable.

摘要

目的

评估基于球囊的双极Vessix肾去神经支配系统治疗顽固性高血压患者的安全性和有效性。

方法与结果

在这项前瞻性、多中心、单臂研究中,146例患者(年龄58.6±10.5岁;61%为男性),尽管使用了最大耐受剂量的≥3种抗高血压药物,但诊室收缩压(BP)≥160 mmHg,接受了Vessix系统治疗。疗效终点为6个月时诊室和24小时动态收缩压和舒张压的降低。评估了急性和长期安全性,重点是肾动脉和估计肾小球滤过率(eGFR)。基线诊室血压和动态血压分别为182.4±18.4/100.2±14.0 mmHg和153.0±15.1/87.5±13.2 mmHg。未发生需要干预的急性肾动脉损伤或严重的围手术期心血管事件。6个月时,诊室血压降低了24.7±22.1/10.3±12.7 mmHg(p<0.0001),动态血压降低了8.4±14.4/5.9±9.1 mmHg(N=69;p<0.0001)。26例患者(18%)的诊室收缩压<140 mmHg。1例患者发生肾动脉狭窄,需要进行支架置入术。平均eGFR保持稳定。

结论

使用Vessix系统进行肾去神经支配可降低顽固性高血压患者6个月时的诊室血压和动态血压。肾动脉安全性和肾功能结果良好。

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