Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Int J Cardiol. 2018 Jan 1;250:29-34. doi: 10.1016/j.ijcard.2017.09.200. Epub 2017 Oct 1.
Microvascular impairment is well documented in hypertension. We investigated the effect of renal sympathetic denervation (RDN) on cardiac and peripheral microvasculature in patients with treatment-resistant essential hypertension (TRH).
A randomized, single centre, double-blinded, sham-controlled clinical trial. Fifty-eight patients with TRH (ambulatory systolic BP (ASBP) ≥ 145mmHg) despite stable treatment were randomized to RDN or SHAM. RDN was performed with the unipolar Medtronic Flex catheter. Coronary flow reserve (CFR) and coronary- and forearm minimum vascular resistance (C-Rmin and F-Rmin) were determined using transthoracic Doppler echocardiography and F-Rmin with venous occlusion plethysmography at baseline and at six-months follow-up.
RDN was performed with 5.3±0.2 lesions in the right renal artery and 5.4±0.2 lesions in the left. Baseline ASBP was 152±2mmHg (RDN, n=29) and 154±2mmHg (SHAM, n=29). Similar reductions in MAP were seen at follow up (-3.5±2.0 vs. -3.2±1.8, P=0.92). Baseline CFR was 2.9±0.1 (RDN) and 2.4±0.1 (SHAM), with no significant change at follow-up (0.2±0.2 vs. -0.1±0.2, P=0.57). C-Rmin was 1.9±0.3 (RDN) and 2.7±0.6 (SHAM) (mmHgmin/ml pr. 100g) and did not change significantly (0.3±0.5 vs. -0.4±0.8, P=0.48). F-Rmin was 3.6±0.2 (RDN) and 3.6±0.3 (SHAM) (mmHgmin/ml pr. 100ml tissue) and unchanged at follow-up (4.2±0.4 vs. 3.8±0.2, P=0.17). Left ventricular mass index was unchanged following RDN (-4±7 (RDN) vs. 3±5 (SHAM) (g/m) P=0.38).
The current study does not support positive effects of RDN on microvascular impairment in TRH.
微血管损伤在高血压中已有充分的记录。我们研究了肾交感神经去神经支配（RDN）对治疗抵抗性原发性高血压（TRH）患者心脏和外周微血管的影响。
这是一项随机、单中心、双盲、假对照的临床试验。58 名 TRH 患者（动态收缩压（ASBP）≥145mmHg）尽管接受了稳定的治疗，但仍随机分为 RDN 或 SHAM 组。使用单极 Medtronic Flex 导管进行 RDN。使用经胸多普勒超声心动图测定冠状动脉血流储备（CFR）和冠状动脉及前臂最小血管阻力（C-Rmin 和 F-Rmin），并在基线和 6 个月随访时使用静脉闭塞容积描记法测定 F-Rmin。
右肾动脉行 5.3±0.2 个消融灶，左肾动脉行 5.4±0.2 个消融灶。基线时 ASBP 为 152±2mmHg（RDN 组，n=29）和 154±2mmHg（SHAM 组，n=29）。随访时 MAP 均有相似的降低（-3.5±2.0 与-3.2±1.8，P=0.92）。基线 CFR 为 2.9±0.1（RDN 组）和 2.4±0.1（SHAM 组），随访时无显著变化（0.2±0.2 与-0.1±0.2，P=0.57）。C-Rmin 为 1.9±0.3（RDN 组）和 2.7±0.6（SHAM 组）（mmHgmin/ml per 100g），无明显变化（0.3±0.5 与-0.4±0.8，P=0.48）。F-Rmin 为 3.6±0.2（RDN 组）和 3.6±0.3（SHAM 组）（mmHgmin/ml per 100ml 组织），随访时无变化（4.2±0.4 与 3.8±0.2，P=0.17）。RDN 后左心室质量指数无变化（-4±7（RDN 组）与 3±5（SHAM 组）（g/m），P=0.38）。
目前的研究结果不支持 RDN 对 TRH 患者微血管损伤的积极影响。
