Zaldivia Maria T K, Rivera Jennifer, Hering Dagmara, Marusic Petra, Sata Yusuke, Lim Bock, Eikelis Nina, Lee Rebecca, Lambert Gavin W, Esler Murray D, Htun Nay M, Duval Jacqueline, Hammond Louise, Eisenhardt Steffen U, Flierl Ulrike, Schlaich Markus P, Peter Karlheinz
From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.).
Hypertension. 2017 Feb;69(2):323-331. doi: 10.1161/HYPERTENSIONAHA.116.08373. Epub 2016 Dec 12.
Overactivation of renal sympathetic nervous system and low-grade systemic inflammation are common features of hypertension. Renal denervation (RDN) reduces sympathetic activity in patients with resistant hypertension. However, its effect on systemic inflammation has not been examined. We prospectively investigated the effect of RDN on monocyte activation and inflammation in patients with uncontrolled hypertension scheduled for RDN. Ambulatory blood pressure, monocyte, and monocyte subset activation and inflammatory markers were assessed at baseline, 3 months, and 6 months after procedure in 42 patients. RDN significantly lowered blood pressure at 3 months (150.5±11.2/81.0±11.2 mm Hg to 144.7±11.8/77.9±11.0 mm Hg), which was sustained at 6 months (144.7±13.8/78.6±11.0 mm Hg). Activation status of monocytes significantly decreased at 3 months (P<0.01) and 6 months (P<0.01) after the procedure. In particular, classical monocyte activation was reduced at 6 months (P<0.05). Similarly, we observed a reduction of several inflammatory markers, including monocyte-platelet aggregates (3 months, P<0.01), plasma monocyte chemoattractant protein-1 levels (3 months, P<0.0001; 6 months, P<0.05), interleukin-1β (3 months, P<0.05; 6 months, P<0.05), tumor necrosis factor-α (3 months, P<0.01; 6 months, P<0.05), and interleukin-12 (3 months, P<0.01; 6 months, P<0.05). A positive correlation was observed between muscle sympathetic nerve activity and monocyte activation before and after the procedure. These results indicate that inhibition of sympathetic activity via RDN is associated with a reduction of monocyte activation and other inflammatory markers in hypertensive patients. These findings point to a direct interaction between the inflammatory and sympathetic nervous system, which is of central relevance for the understanding of beneficial cardiovascular effects of RDN.
肾交感神经系统过度激活和低度全身炎症是高血压的常见特征。肾去神经支配术（RDN）可降低顽固性高血压患者的交感神经活性。然而，其对全身炎症的影响尚未得到研究。我们前瞻性地研究了RDN对计划接受RDN的未控制高血压患者单核细胞激活和炎症的影响。对42例患者在基线、术后3个月和6个月时评估动态血压、单核细胞、单核细胞亚群激活及炎症标志物。RDN在3个月时显著降低血压（从150.5±11.2/81.0±11.2 mmHg降至144.7±11.8/77.9±11.0 mmHg），并在6个月时维持（144.7±13.8/78.6±11.0 mmHg）。术后3个月（P<0.01）和6个月（P<0.01）时单核细胞的激活状态显著降低。特别是，6个月时经典单核细胞激活减少（P<0.05）。同样，我们观察到几种炎症标志物减少，包括单核细胞 - 血小板聚集体（3个月，P<0.01）、血浆单核细胞趋化蛋白 -1水平（3个月，P<0.0001；6个月，P<0.05）、白细胞介素 -1β（3个月，P<0.05；6个月，P<)05）、肿瘤坏死因子 -α（3个月，P<0.01；6个月，P<0.05）和白细胞介素 - (3个月，P<0.01；6个月，P<0.05）。术前和术后肌肉交感神经活性与单核细胞激活之间均观察到正相关。这些结果表明，通过RDN抑制交感神经活性与高血压患者单核细胞激活及其他炎症标志物的减少有关。这些发现表明炎症和交感神经系统之间存在直接相互作用，这对于理解RDN有益的心血管效应至关重要。
