Ott Christian, Lobo Melvin D, Sobotka Paul A, Mahfoud Felix, Stanton Alice, Cockcroft John, Sulke Neil, Dolan Eamon, van der Giet Markus, Hoyer Joachim, Furniss Stephen S, Foran John P, Witkowski Adam, Januszewicz Andrzej, Schoors Danny, Tsioufis Konstantinos, Rensing Benno J, Saxena Manish, Scott Benjamin, Ng G André, Achenbach Stephan, Schmieder Roland E
Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom.
J Am Heart Assoc. 2016 Dec 21;5(12):e004234. doi: 10.1161/JAHA.116.004234.
Options for interventional therapy to lower blood pressure (BP) in patients with treatment-resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH.
The randomized, controlled, prospective ROX Control Hypertension Study included patients with true treatment-resistant hypertension (office systolic BP ≥140 mm Hg, average daytime ambulatory BP ≥135/85 mm Hg, and treatment with ≥3 antihypertensive drugs including a diuretic). In a post hoc analysis, we stratified patients with CH (n=31) and ISH (n=11). Baseline office systolic BP (177±18 mm Hg versus 169±17 mm Hg, P=0.163) and 24-hour ambulatory systolic BP (159±16 mm Hg versus 154±11 mm Hg, P=0.463) did not differ between patients with CH and those with ISH. ROX coupler implementation resulted in a significant reduction in office systolic BP (CH: -29±21 mm Hg versus ISH: -22±31 mm Hg, P=0.445) and 24-hour ambulatory systolic BP (CH: -14±20 mm Hg versus ISH: -13±15 mm Hg, P=0.672), without significant differences between the two groups. The responder rate (office systolic BP reduction ≥10 mm Hg) after 6 months was not different (CH: 81% versus ISH: 82%, P=0.932).
Our data suggest that creation of an arteriovenous anastomosis using the ROX coupler system leads to a similar reduction of office and 24-hour ambulatory systolic BP in patients with combined and isolated systolic hypertension.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498.
对于难治性高血压患者，降低血压（BP）的介入治疗选择包括肾去神经支配以及使用ROX耦合器建立动静脉吻合术。研究表明，合并高血压（CH）患者肾去神经支配后的血压反应比单纯收缩期高血压（ISH）患者更大。我们分析了与ISH患者相比，ROX耦合器植入对CH患者的影响。
随机、对照、前瞻性的ROX控制高血压研究纳入了真正的难治性高血压患者（诊室收缩压≥140mmHg，平均日间动态血压≥135/85mmHg，且使用≥3种抗高血压药物包括利尿剂进行治疗）。在一项事后分析中，我们将CH患者（n = 31）和ISH患者（n = 11）进行了分层。CH患者和ISH患者的基线诊室收缩压（177±18mmHg对169±17mmHg，P = 0.163）和24小时动态收缩压（159±16mmHg对154±11mmHg，P = 0.463）并无差异。ROX耦合器植入导致诊室收缩压显著降低（CH组：-29±21mmHg对ISH组：-22±31mmHg，P = 0.445）以及24小时动态收缩压显著降低（CH组：-14±20mmHg对ISH组：-13±15mmHg，P = 0.672），两组之间无显著差异。6个月后的反应率（诊室收缩压降低≥10mmHg）无差异（CH组：81%对ISH组：82%，P = 0.932）。
我们的数据表明，使用ROX耦合器系统建立动静脉吻合术可使合并收缩期高血压和单纯收缩期高血压患者的诊室和24小时动态收缩压出现相似程度的降低。
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