Vogiatzakis Nikos, Tsioufis Costas, Georgiopoulos Georgios, Thomopoulos Costas, Dimitriadis Kyriakos, Kasiakogias Alexandros, Konstantinidis Dimitrios, Kalos Thodoris, Mahfoud Felix, Doumas Michael, Papademetriou Vasilios, Tousoulis Dimitrios
aFirst Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece bDepartment of Internal Medicine, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Saarland, Germany cSecond Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece dVeteran Affairs Medical Center and Georgetown University, Washington, District of Columbia, USA.
J Hypertens. 2017 Sep;35(9):1750-1757. doi: 10.1097/HJH.0000000000001391.
BACKGROUND/OBJECTIVES: Short-term blood pressure variability (BPV) is affected by multiple factors including the sympathetic nervous system drive. Regarding the latter, the novel interventional technology of renal denervation (RDN), by modulating the sympathetic system activation, could have a beneficial impact on BPV. The aim of the current study is to review and meta-analyze the available evidence on the effect of RDN on short-term BPV.
We searched Medline/PubMed database until October 2016 for studies with eligible content. We performed random-effect meta-analyses for 12 outcomes of interest: the standard deviation (SD) of SBP (24 h, daytime and night-time) and DBP (24 h, daytime and night-time), the weighted SD of SBP and DBP across 24 h, the coefficient of variation of SBP and DBP across 24 h and the average real variability of SBP and DBP across 24 h.
RDN reduced the SD of SBP across 24 h [mean change: -1.212 (95% confidence intervals (CIs): -2.354/-0.071), P = 0.037] and decreased the SD of systolic daytime BP [mean difference: -1.617 (95% CIs: -3.21/-0.026), P = 0.046] and diastolic daytime BP (marginally) [mean difference: -2.605 (95% CIs: -5.21/-0.003), P = 0.05]. The effect of RDN in reducing SD of SBP across 24 h or DBP across daytime was not influenced by absolute or relative reduction in SBP and DBP indices. (P > 0.1 for all).
Catheter-based RDN in resistant hypertensive patients can favorably affect short-term BPV, independent of the level of BP reduction. Further investigation of the effect of RDN on BPV is needed with large randomized trials.
背景/目的：短期血压变异性（BPV）受包括交感神经系统驱动在内的多种因素影响。关于后者，肾去神经支配（RDN）这项新型介入技术，通过调节交感神经系统激活，可能对BPV产生有益影响。本研究的目的是回顾和荟萃分析关于RDN对短期BPV影响的现有证据。
我们检索了Medline/PubMed数据库至2016年10月，以查找符合条件的研究。我们对12个感兴趣的结局进行了随机效应荟萃分析：收缩压（SBP）的标准差（SD）（24小时、日间和夜间）和舒张压（DBP）的标准差（SD）（24小时、日间和夜间）、24小时内SBP和DBP的加权标准差、24小时内SBP和DBP的变异系数以及24小时内SBP和DBP的平均实际变异性。
RDN降低了24小时内SBP的标准差[平均变化：-1.212（95%置信区间（CIs）：-2.354/-0.071），P = 0.037]，并降低了日间收缩压的标准差[平均差异：-1.617（95% CIs：-3.21/-0.026），P = 0.046]以及日间舒张压（临界）[平均差异：-2.605（95% CIs：-5.21/-0.003），P = 0.05]。RDN降低24小时内SBP标准差或日间DBP标准差的效果不受SBP和DBP指数绝对或相对降低的影响。（所有P>0.1）。
基于导管的RDN治疗难治性高血压患者可对短期BPV产生有利影响，且与血压降低水平无关。需要通过大型随机试验进一步研究RDN对BPV的影响。
