de Leeuw Peter W, Bisognano John D, Bakris George L, Nadim Mitra K, Haller Hermann, Kroon Abraham A
From the Department of Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (P.W.d.L., A.A.K.); Department of Medicine, Zuyderland Medisch Centrum, Sittard, The Netherlands (P.W.d.L.); Department of Medicine, University of Rochester, NY (J.D.B.); Department of Medicine, University of Chicago Medicine, IL (G.L.B.); Department of Medicine, University of Southern California, Los Angeles (M.K.N.); and Department of Nephrology, Medizinische Hochschule Hannover, Germany (H.H.).
Hypertension. 2017 May;69(5):836-843. doi: 10.1161/HYPERTENSIONAHA.117.09086. Epub 2017 Mar 20.
Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term follow-up data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of follow-up and 48 patients had completed 6 years of follow-up. In the entire cohort, office systolic blood pressure fell from 179±24 mm Hg to 144±28 mm Hg (<0.0001), whereas office diastolic pressure dropped from 103±16 mm Hg to 85±18 mm Hg (<0.0001). Heart rate fell from 74±15 beats per minute to 71±13 beats per minute (<0.02). The effect of baroreflex activation therapy is greater than average in patients with signs of heart failure and less than average in patients with isolated systolic hypertension. In ≈25% of patients, it was possible to reduce the number of medications from a median of 6 to a median of 3. Temporary side effects, related to either the surgical procedure or the cardiovascular instability, do occur, but they do not require specific measures and resolve over time.After a follow-up of 6 years, baroreflex activation therapy maintains its efficacy for persistent reduction of office blood pressure in patients with resistant hypertension without major safety issues.
压力反射激活疗法是一种治疗顽固性高血压患者的新技术。尽管短期研究表明该疗法可降低血压，但长期结果尚未见报道。本研究的目的是评估压力反射激活疗法的长期疗效和安全性。对纳入3项针对顽固性高血压患者试验中1项的所有患者的长期随访数据进行了分析。总共383例患者可供分析：其中143例完成了5年随访，48例完成了6年随访。在整个队列中，诊室收缩压从179±24 mmHg降至144±28 mmHg（<0.0001），而诊室舒张压从103±16 mmHg降至85±18 mmHg（<0.0001）。心率从74±15次/分钟降至71±13次/分钟（<0.02）。压力反射激活疗法对心力衰竭患者的效果大于平均水平，对单纯收缩期高血压患者的效果小于平均水平。约25%的患者能够将药物数量从中位数6种减少至中位数3种。确实会出现与手术操作或心血管不稳定相关的暂时性副作用，但无需采取特殊措施，且会随时间自行缓解。经过6年随访，压力反射激活疗法在顽固性高血压患者中持续降低诊室血压的疗效得以维持，且无重大安全问题。
