Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Therapeutic Service Center, Chongqing.
Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong SAR, China.
J Hypertens. 2018 Dec;36(12):2460-2470. doi: 10.1097/HJH.0000000000001839.
Previous studies showed that radiofrequency energy delivery of the renal artery could induce an immediate and substantial blood pressure (BP)-elevation response, which might be indicative of the increase in central sympathetic nervous activity.
The current study was to investigate whether the presence of BP-elevation response to radiofrequency energy delivery can serve as a surrogate to predict BP reduction following renal artery sympathetic denervation (RDN).
Data were collected on 67 patients undergoing RDN for drug-resistant hypertension. The BP-elevation response to radiofrequency application was defined as elevation of SBP by at least 10 mmHg during radiofrequency energy delivery. The extent of BP reduction at 1, 3, 6, 12 months after RDN were analyzed. Multivariable linear regression analysis of baseline and procedural characteristics was performed to identify the determinants of BP reduction after RDN.
Ten patients (14.9%) were classified as nonresponders to radiofrequency delivery and showed significantly lower BP reduction compared with responders. The SBP reductions of radiofrequency delivery responders vs. nonresponders were 31.2 ± 8.6 vs. 11.4 ± 8.6 mmHg, 36.3 ± 10.0 vs. 14.6 ± 10.6 mmHg, 39.9 ± 9.9 vs. 15.2 ± 8.8 mmHg, and 40.0 ± 8.7/13.5 ± 5.8 mmHg (P < 0.001 for all) at 1, 3, 6, and 12 months, respectively. On multiple linear regression analysis, higher baseline office SBP, the presence of BP-elevation response to radiofrequency energy delivery, and especially larger number of BP-elevation response points, were independent predictors of SBP reduction at 6-month and 12-month follow-up.
Baseline SBP and BP-elevation response during radiofrequency ablation, as well as larger positive response points to radiofrequency energy delivery could be an effective intraprocedural predictive markers to long-term procedural success of RDN.
先前的研究表明，射频能量传递到肾动脉可立即引起显著的血压升高反应，这可能表明中枢交感神经活动增加。
本研究旨在探讨射频能量传递引起的血压升高反应是否可以作为预测肾动脉交感神经去神经支配（RDN）后血压降低的替代指标。
收集了 67 例接受 RDN 治疗药物抵抗性高血压的患者的数据。射频应用时收缩压升高至少 10mmHg 定义为射频能量传递时的收缩压升高反应。分析 RDN 后 1、3、6、12 个月的血压降低程度。对基线和手术特征进行多变量线性回归分析，以确定 RDN 后血压降低的决定因素。
10 例（14.9%）患者被归类为射频传递无反应者，与有反应者相比，血压降低幅度明显较低。射频传递有反应者与无反应者的收缩压降低分别为 31.2±8.6mmHg 比 11.4±8.6mmHg、36.3±10.0mmHg 比 14.6±10.6mmHg、39.9±9.9mmHg 比 15.2±8.8mmHg 和 40.0±8.7/13.5±5.8mmHg（所有 P 值均<0.001），分别在 1、3、6 和 12 个月时。多元线性回归分析显示，较高的基线诊室收缩压、射频能量传递时的血压升高反应以及特别是更多的血压升高反应点，是 6 个月和 12 个月随访时收缩压降低的独立预测因素。
基线收缩压和射频消融期间的血压升高反应，以及射频能量传递的更大阳性反应点可能是 RDN 长期手术成功的有效术中预测指标。
