Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain.
Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
J Hypertens. 2018 Feb;36(2):221-229. doi: 10.1097/HJH.0000000000001582.
Sympathetic tone is one of the main determinants of blood pressure (BP) variability and treatment-resistant hypertension. The aim of our study was to assess changes in BP variability after renal denervation (RDN). In addition, on an exploratory basis, we investigated whether baseline BP variability predicted the BP changes after RDN.
We analyzed 24-h BP recordings obtained at baseline and 6 months after RDN in 167 treatment-resistant hypertension patients (40% women; age, 56.7 years; mean 24-h BP, 152/90 mmHg) recruited at 11 expert centers. BP variability was assessed by weighted SD [SD over time weighted for the time interval between consecutive readings (SDiw)], average real variability (ARV), coefficient of variation, and variability independent of the mean (VIM).
Mean office and 24-h BP fell by 15.4/6.6 and 5.5/3.7 mmHg, respectively (P < 0.001). In multivariable-adjusted analyses, systolic/diastolic SDiw and VIM for 24-h SBP/DBP decreased by 1.18/0.63 mmHg (P ≤ 0.01) and 0.86/0.42 mmHg (P ≤ 0.05), respectively, whereas no significant changes in ARV or coefficient of variation occurred. Furthermore, baseline SDiw (P = 0.0006), ARV (P = 0.01), and VIM (P = 0.04) predicted the decrease in 24-h DBP but not 24-h SBP after RDN.
RDN was associated with a decrease in BP variability independent of the BP level, suggesting that responders may derive benefits from the reduction in BP variability as well. Furthermore, baseline DBP variability estimates significantly correlated with mean DBP decrease after RDN. If confirmed in younger patients with less arterial damage, in the absence of the confounding effect of drugs and drug adherence, baseline BP variability may prove a good predictor of BP response to RDN.
交感神经张力是血压（BP）变异性和治疗抵抗性高血压的主要决定因素之一。我们的研究目的是评估肾去神经支配（RDN）后 BP 变异性的变化。此外，我们还在探索性基础上研究了基线 BP 变异性是否预测 RDN 后的 BP 变化。
我们分析了 11 个专家中心招募的 167 例治疗抵抗性高血压患者（40%为女性；年龄 56.7 岁；平均 24 小时 BP 为 152/90mmHg）在 RDN 前后 24 小时的 BP 记录。BP 变异性通过加权标准差（SDiw）[按连续读数之间的时间间隔加权的时间 SD（SDiw）]、平均真实变异性（ARV）、变异系数和均值无关的变异性（VIM）来评估。
平均诊室和 24 小时 BP 分别下降了 15.4/6.6mmHg 和 5.5/3.7mmHg（P＜0.001）。在多变量调整分析中，24 小时 SBP/DBP 的收缩压/舒张压 SDiw 和 VIM 分别下降了 1.18/0.63mmHg（P≤0.01）和 0.86/0.42mmHg（P≤0.05），而 ARV 或变异系数没有显著变化。此外，基线 SDiw（P=0.0006）、ARV（P=0.01）和 VIM（P=0.04）预测了 RDN 后 24 小时 DBP 的下降，但不能预测 24 小时 SBP 的下降。
RDN 与 BP 水平无关的 BP 变异性降低相关，提示对 RDN 有反应的患者可能从 BP 变异性的降低中获益。此外，基线 DBP 变异性估计与 RDN 后平均 DBP 下降显著相关。如果在动脉损伤较小、无药物和药物依从性混杂影响的年轻患者中得到证实，那么基线 BP 变异性可能成为 RDN 后 BP 反应的良好预测指标。
