Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
Clin Res Cardiol. 2015 Sep;104(9):782-9. doi: 10.1007/s00392-015-0845-0. Epub 2015 Apr 28.
High pulsatile pressure and flow in the arteries causes microvascular damage, and hence increased cardio-, and cerebrovascular complications. With advanced stages of hypertensive disease, an exaggerated pulsatile retinal capillary flow (RCF) has been shown, but data about interventional effect are missing.
Fifty-one patients with true treatment-resistant hypertension (TRH) underwent renal denervation (RDN) using the Symplicity Flex(™) catheter and were followed for 12 months. RCF was assessed non-invasively using Scanning laser Doppler flowmetry (SLDF) before, 6 (6 M), and 12 (12 M) months after RDN. RCF was measured in systole and diastole and pulsed RCF (difference of RCF in systole minus diastole) was calculated. In addition, flicker light-induced vasodilation (representing vasodilatory capacity) was assessed.
Systolic and diastolic office blood pressure (BP) as well as 24-h ABPM decreased significantly 6 M and 12 M after RDN, compared to baseline values (all p < 0.001). There was a significant reduction of pulsed RCF 6 M (231 ± 81 versus 208 ± 68 AU, p = 0.046) and 12 M (194 ± 72 AU, p = 0.001) after RDN, whereas the mean RCF was unchanged. Moreover, there was a significant increase of flicker light-induced vasodilation after RDN (p = 0.043).
In hypertensive patients with TRH, we observed a decrease of pulsed RCF 6 M and 12 M after RDN and an increase of vasodilatory capacity, in parallel to decreases in BP and heart rate. The reduction of pulsed RCF after RDN implies a decrease of shear stress on the vascular wall by the pulsed blood flow. This and the increment of vasodilatory capacity suggest an improvement of retinal (and potentially cerebral) microcirculation.
动脉中的高脉动压力和流量会导致微血管损伤，从而增加心血管和脑血管并发症。在高血压疾病的晚期阶段，已经显示出夸张的脉动视网膜毛细血管流量（RCF），但缺乏关于干预效果的数据。
51 名患有真性治疗抵抗性高血压（TRH）的患者接受了使用 Symplicity Flex（™）导管的肾去神经支配（RDN）治疗，并在 RDN 后随访 12 个月。在 RDN 之前、6 个月（6M）和 12 个月（12M）时，使用扫描激光多普勒血流仪（SLDF）非侵入性地评估 RCF。RCF 在收缩期和舒张期进行测量，并计算脉动 RCF（收缩期减去舒张期的 RCF 差异）。此外，评估闪烁光诱导的血管舒张（代表血管舒张能力）。
与基线值相比，RDN 后 6 个月和 12 个月时收缩期和舒张期诊室血压（BP）以及 24 小时 ABPM 显著降低（均 p < 0.001）。RDN 后 6 个月（231 ± 81 对 208 ± 68 AU，p = 0.046）和 12 个月（194 ± 72 AU，p = 0.001）时脉动 RCF 显著降低，而平均 RCF 不变。此外，RDN 后闪烁光诱导的血管舒张显著增加（p = 0.043）。
在患有 TRH 的高血压患者中，我们观察到 RDN 后 6 个月和 12 个月时脉动 RCF 降低，并且血管舒张能力增加，同时 BP 和心率降低。RDN 后脉动 RCF 的降低意味着脉动血流对血管壁的剪切应力降低。这种和血管舒张能力的增加表明视网膜（和潜在的脑）微循环得到改善。
