动脉僵硬度评估的脉搏波速度不能预测原发性醛固酮增多症肾上腺手术后高血压的改善：来自法国高血压卓越中心欧洲高血压学会的多中心研究。

Arterial stiffness evaluated by pulse wave velocity is not predictive of the improvement in hypertension after adrenal surgery for primary aldosteronism: A multicentre study from the French European Society of Hypertension Excellence Centres.

机构信息

Department of Therapeutics and Hypertension, Rangueil University Hospital, 31059 Toulouse, France; UMR 1027 INSERM Toulouse 3 University, 31000 Toulouse, France.

Department of Therapeutics and Hypertension, Rangueil University Hospital, 31059 Toulouse, France; INSERM 1048 Toulouse 3 University, 31432 Toulouse, France.

出版信息

Arch Cardiovasc Dis. 2018 Oct;111(10):564-572. doi: 10.1016/j.acvd.2018.01.004. Epub 2018 Mar 16.

DOI:10.1016/j.acvd.2018.01.004

PMID:29555192

Abstract

BACKGROUND

Predictive factors associated with normal blood pressure (BP) after unilateral adrenalectomy for primary aldosteronism (PA) are not clearly identified.

AIMS

To evaluate the predictive value of arterial stiffness before surgery on BP after surgery.

METHODS

During 2009-2013, 96 patients with PA due to unilateral adrenal adenoma who underwent surgery were enrolled in a multicentre open-label, prospective study. Aortic pulse wave velocity (PWV) was assessed before surgery. Patients underwent ambulatory blood pressure monitoring (ABPM) before surgery and 6 and 12months after surgery. Twenty-four h SBP/DBP values were compared in subjects with PWV<vs. ≥10m/s. The primary outcome was 24-hour ABPM<130/80mmHg 6 months after adrenalectomy.

RESULTS

BP and PWV were available for 82 patients (mean age 49±12years). Mean 24-hour systolic/diastolic BP (SBP/DBP) values decreased from 144±15/91±9 before surgery to 131±15/84±11mmHg 6months after surgery. At 6months, mean 24-hour SBP did not differ significantly between high versus low PWV groups (SBP-0.8mmHg, 95% confidence interval-6.9 to 5.2, P=0.79). A total of 42.3% of women versus 20.0% of men had 24-hour SBP/DBP<130/80mmHg at 6months (P=0.07) and 57.9% vs. 23.8% at 12months (P=0.03). Higher SBP/DBP was recorded for men versus women after 6months (P=0.01/0.001) and 1year (P=0.04/0.05).

CONCLUSION

Preoperative arterial stiffness does not predict a beneficial effect of adrenalectomy on BP values.

摘要

背景

原发性醛固酮增多症（PA）患者行单侧肾上腺切除术（UA）后血压（BP）恢复正常的预测因素尚不清楚。

目的

评估术前动脉僵硬度对术后 BP 的预测价值。

方法

2009 年至 2013 年，96 例单侧肾上腺腺瘤所致 PA 患者行手术治疗，入组一项多中心、开放标签、前瞻性研究。术前评估主动脉脉搏波速度（PWV）。术前及术后 6 个月和 12 个月行动态血压监测（ABPM）。比较 PWV<vs.≥10m/s 的患者 24 h 收缩压/舒张压（SBP/DBP）值。主要结局是 UA 后 6 个月 24 h ABPM<130/80mmHg。

结果

82 例患者（平均年龄 49±12 岁）的 BP 和 PWV 数据可用。术前 24 h 平均 SBP/DBP 值从 144±15/91±9mmHg 降至术后 6 个月的 131±15/84±11mmHg。术后 6 个月，高 PWV 组与低 PWV 组 24 h 平均 SBP 差异无统计学意义（SBP-0.8mmHg，95%置信区间-6.9 至 5.2，P=0.79）。6 个月时，女性中有 42.3%（n=34）、男性中有 20.0%（n=17）的 24 h SBP/DBP<130/80mmHg（P=0.07），12 个月时，女性中有 57.9%（n=47）、男性中有 23.8%（n=19）的 24 h SBP/DBP<130/80mmHg（P=0.03）。术后 6 个月和 1 年，男性的 SBP/DBP 均高于女性（P=0.01/0.001 和 P=0.04/0.05）。