Sharp Andrew S P, Davies Justin E, Lobo Melvin D, Bent Clare L, Mark Patrick B, Burchell Amy E, Thackray Simon D, Martin Una, McKane William S, Gerber Robert T, Wilkinson James R, Antonios Tarek F, Doulton Timothy W, Patterson Tiffany, Clifford Piers C, Lindsay Alistair, Houston Graeme J, Freedman Jonathan, Das Neelan, Belli Anna M, Faris Mohamad, Cleveland Trevor J, Nightingale Angus K, Hameed Awais, Mahadevan Kalaivani, Finegold Judith A, Mather Adam N, Levy Terry, D'Souza Richard, Riley Peter, Moss Jonathan G, Di Mario Carlo, Redwood Simon R, Baumbach Andreas, Caulfield Mark J, Dasgupta Indranil
Department of Cardiology, Royal Devon and Exeter NHS Foundation Trust, University of Exeter, Barrack Road, Exeter, EX2 5DW, UK.
International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK.
Clin Res Cardiol. 2016 Jun;105(6):544-52. doi: 10.1007/s00392-015-0959-4. Epub 2016 Jan 22.
Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.
We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.
Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2).
In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.
肾去神经支配术（RDN）可能会降低血压（BP）；然而，尚不清楚药物治疗的改变是否会混淆结果。此外，关于动态血压（ABP）反应模式的数据有限，尤其是在接受RDN治疗时正在服用醛固酮拮抗剂的患者中。
我们研究了英国18个中心所有接受RDN治疗顽固性高血压的患者。
展示了253例接受五种技术治疗的患者的结果。术前平均诊室血压（OBP）为185/102 mmHg（标准差26/19；n = 253），平均日间ABP为170/98 mmHg（标准差22/16；n = 186）。抗高血压药物的中位数为5.0：96%为ACEI/ARB；86%为噻嗪类/襻利尿剂，55%为醛固酮拮抗剂。在11个月随访时，90%的患者有OBP数据，为163/93 mmHg（降低22/9 mmHg）。在8.5个月随访时，70%的患者有ABP数据，为158/91 mmHg（下降12/7 mmHg）。RDN术后平均药物变化为：增加0.36种药物，停用0.91种药物。剂量变化似乎呈中性。根据起始ABP进行四分位数分析显示，RDN术后收缩压ABP的平均降低值分别为：0.4、6.5、14.5和22.1 mmHg（趋势p < 0.001）。使用醛固酮拮抗剂并不能预测反应（p > 0.2）。
在253例接受RDN治疗的患者中，诊室血压下降了22/9 mmHg。动态血压下降了12/7 mmHg，尽管在起始血压最低的四分位数中几乎没有看到反应。血压下降不能用药物治疗的改变来解释，使用醛固酮拮抗剂也不影响反应。
