肾去神经支配术对中度难治性高血压且已证实坚持服药患者的疗效。

The effect of renal denervation in moderate treatment-resistant hypertension with confirmed medication adherence.

作者信息

Ott Christian, Mahfoud Felix, Schmid Axel, Ewen Sebastian, Toennes Stefan W, Meyer Markus R, Helfer Andreas G, Maurer Hans H, Ditting Tilmann, Veelken Roland, Zivanovic Ina, Uder Michael, Böhm Michael, Schmieder Roland E

机构信息

aDepartment of Nephrology and Hypertension, University Hospital of the Friedrich-Alexander University Erlangen-Nümburg, Erlangen bKlinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar cDepartment of Radiology, University Hospital of the Friedrich-Alexander University Erlangen-Nürnberg, Erlangen dInstitute of Legal Medicine, Forensic Toxicology Department, Goethe University, Frankfurt/Main eAbteilung für Experimentelle und Klinische Pharmakologie, Universität des Saarlandes, Homburg/Saar, Germany.

出版信息

J Hypertens. 2016 Dec;34(12):2475-2479. doi: 10.1097/HJH.0000000000001110.

DOI:10.1097/HJH.0000000000001110

PMID:27607458

Abstract

OBJECTIVES

Data on the blood pressure (BP)-lowering effect of renal denervation (RDN) in moderate treatment-resistant hypertension (TRH) are limited. Moreover, change of adherence to medication, as one potential confounder of BP response, has never been analyzed rigorously in this group of patients. We analyzed the effect of RDN on BP in patients with moderate TRH who were retrospectively found to be completely adherent to their antihypertensive medication.

METHODS

Our study cohort comprised 40 patients with moderate TRH [office BP ≥ 140/90 but <160/100 mmHg and 24-h ambulatory BP monitoring (ABPM) ≥130/80 mmHg] who underwent catheter-based RDN. Further major inclusion criterion was complete adherence to their medication (≥80% intake of their prescribed antihypertensive drugs) at baseline (assessed by retrospective toxicological analysis).

RESULTS

Six months after RDN, office BP was reduced by -10/-6 mmHg (SBP: 149 ± 6 vs. 139 ± 15 mmHg; DBP: 81 ± 12 vs. 75 ± 10 mmHg; both P < 0.001) and 24-h ABPM by -7/-4 mmHg (SBP: 150 ± 14 vs. 143 ± 16 mmHg, P = 0.005; DBP: 82 ± 10 vs. 78 ± 9 mmHg, P = 0.009). Number of prescribed antihypertensive medication [6.0 (5.0-6.0) vs. 5.5 (5.0-6.0), P = 0.013] and adherence rate (95.2 ± 7.6 vs. 91.7 ± 13.9%, P = 0.065) was slightly reduced 6 months after RDN, both likely to underestimate the true BP reduction.

CONCLUSION

Thus, our data indicate that even after given full respect to drug adherence as potential confounder of BP response after RDN, both office and 24-h ABPM were substantially reduced in patients with moderate TRH.

摘要

目的

肾去神经支配术（RDN）对中度顽固性高血压（TRH）患者的降压效果数据有限。此外，作为血压反应的一个潜在混杂因素，药物依从性的变化在这类患者中从未得到过严格分析。我们分析了RDN对中度TRH患者血压的影响，这些患者经回顾性分析发现完全依从其抗高血压药物治疗。

方法

我们的研究队列包括40例中度TRH患者[诊室血压≥140/90但<160/100 mmHg且24小时动态血压监测（ABPM）≥130/80 mmHg]，他们接受了基于导管的RDN。另一个主要纳入标准是在基线时完全依从其药物治疗（规定的抗高血压药物摄入量≥80%）（通过回顾性毒理学分析评估）。

结果

RDN术后6个月，诊室血压降低了-10/-6 mmHg（收缩压：149±6 vs. 139±15 mmHg；舒张压：81±12 vs. 75±10 mmHg；P均<0.001），24小时ABPM降低了-7/-4 mmHg（收缩压：150±14 vs. 143±16 mmHg，P = 0.005；舒张压：82±10 vs. 78±9 mmHg，P = 0.009）。RDN术后6个月，规定的抗高血压药物数量[6.0（5.0 - 6.0）vs. 5.5（5.0 - 6.0），P = 0.013]和依从率（95.2±7.6 vs. 91.7±13.9%，P = 0.065）略有降低，两者可能都低估了实际的血压降低幅度。