Howden Erin J, East Cara, Lawley Justin S, Stickford Abigail S L, Verhees Myrthe, Fu Qi, Levine Benjamin D
Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA.
University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Am J Hypertens. 2017 Jun 1;30(6):632-641. doi: 10.1093/ajh/hpx018.
Whether renal denervation (RDN) in patients with resistant hypertension normalizes blood pressure (BP) regulation in response to routine cardiovascular stimuli such as upright posture is unknown. We conducted an integrative study of BP regulation in patients with resistant hypertension who had received RDN to characterize autonomic circulatory control.
Twelve patients (60 ± 9 [SD] years, n = 10 males) who participated in the Symplicity HTN-3 trial were studied and compared to 2 age-matched normotensive (Norm) and hypertensive (unmedicated, HTN) control groups. BP, heart rate (HR), cardiac output (Qc), muscle sympathetic nerve activity (MSNA), and neurohormonal variables were measured supine, and 30° (5 minutes) and 60° (20 minutes) head-up-tilt (HUT). Total peripheral resistance (TPR) was calculated from mean arterial pressure and Qc.
Despite treatment with RDN and 4.8 (range, 3-7) antihypertensive medications, the RDN had significantly higher supine systolic BP compared to Norm and HTN (149 ± 15 vs. 118 ± 6, 108 ± 8 mm Hg, P < 0.001). When supine, RDN had higher HR, TPR, MSNA, plasma norepinephrine, and effective arterial elastance compared to Norm. Plasma norepinephrine, Qc, and HR were also higher in the RDN vs. HTN. During HUT, BP remained higher in the RDN, due to increases in Qc, plasma norepinephrine, and aldosterone.
We provide evidence of a possible mechanism by which BP remains elevated post RDN, with the observation of increased Qc and arterial stiffness, as well as plasma norepinephrine and aldosterone levels at approximately 2 years post treatment. These findings may be the consequence of incomplete ablation of sympathetic renal nerves or be related to other factors.
对于顽固性高血压患者，肾脏去神经支配术（RDN）能否使血压（BP）调节恢复正常以应对诸如直立姿势等常规心血管刺激尚不清楚。我们对接受RDN的顽固性高血压患者的血压调节进行了一项综合研究，以表征自主循环控制情况。
对参与Symplicity HTN - 3试验的12名患者（60±9[标准差]岁，n = 10名男性）进行研究，并与2个年龄匹配的正常血压（Norm）和高血压（未用药，HTN）对照组进行比较。在仰卧位、头高位倾斜30°（5分钟）和60°（20分钟）（HUT）时测量血压、心率（HR）、心输出量（Qc）、肌肉交感神经活动（MSNA）和神经激素变量。总外周阻力（TPR）由平均动脉压和Qc计算得出。
尽管接受了RDN治疗以及4.8（范围3 - 7）种抗高血压药物治疗，但与Norm和HTN相比，RDN组仰卧位收缩压显著更高（149±15 vs. 118±6，108±8 mmHg，P < 0.001）。仰卧位时，与Norm相比，RDN组的HR、TPR、MSNA、血浆去甲肾上腺素和有效动脉弹性更高。与HTN相比，RDN组的血浆去甲肾上腺素、Qc和HR也更高。在HUT期间，由于Qc、血浆去甲肾上腺素和醛固酮增加，RDN组的血压仍然更高。
我们提供了证据表明RDN术后血压仍升高的一种可能机制，观察到治疗后约2年时Qc增加、动脉僵硬度增加以及血浆去甲肾上腺素和醛固酮水平升高。这些发现可能是交感肾神经未完全消融的结果，或者与其他因素有关。
