Bartus Krzysztof, Litwinowicz Radoslaw, Sadowski Jerzy, Zajdel Wojciech, Brzezinski Maciej, Bartus Magdalena, Kleczyński Paweł, Bartus Stanislaw, Lakkireddy Dhanunjaya, Kapelak Boguslaw
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
Department of Interventional Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2018;14(3):270-275. doi: 10.5114/aic.2018.78330. Epub 2018 Sep 21.
Renal denervation (RD) can lead to a significant and sustained decrease in mean values of arterial blood pressure (BP). However, there is still a subset of patients without a significant BP drop after RD (non-responders).
To compare characteristics of RD responders to RD non-responders and to identify the clinical predictors of BP reduction.
Thirty-one patients with diagnosed resistant hypertension underwent RD. Three years after RD the analysis of BP reduction was performed in regard to the baseline patient characteristics.
After 3 years' follow-up a 10% or more reduction of systolic baseline BP was observed in 74% of patients. Ten percent or more reduction of diastolic baseline BP was observed in 71% of patients. Among responders we observed the following risk factors: hypercholesterolemia in 70%, body mass index (BMI) > 30 kg/m in 55%, diabetes mellitus in 35%, current smoking in 5%. Comorbidity included coronary artery disease (CAD) in 30%, cardiomyopathy in 10%, chronic obstructive pulmonary disease (COPD) in 10%, renal insufficiency in 10%, and ventricular arrhythmia in 5%. Among non-responders we observed the following risk factors: hypercholesterolemia in 38%, diabetes mellitus type 2 in 38% and BMI > 30 kg/m in 86%. Comorbidity included CAD in 50% and cardiomyopathy in 13% of patients.
A 10% reduction of systolic baseline BP was observed in 74% of patients 3 years after renal denervation. Clinical factors like COPD, chronic kidney disease 3a, female sex and hypercholesterolemia increase the chances of effective reduction of BP.
肾去神经支配术（RD）可导致动脉血压（BP）平均值显著且持续下降。然而，仍有一部分患者在接受RD后血压未出现显著下降（无反应者）。
比较RD反应者与无反应者的特征，并确定血压降低的临床预测因素。
31例确诊为顽固性高血压的患者接受了RD。RD三年后，根据患者基线特征对血压降低情况进行分析。
随访3年后，74%的患者收缩压基线下降10%或更多。71%的患者舒张压基线下降10%或更多。在反应者中，我们观察到以下危险因素：高胆固醇血症占70%，体重指数（BMI）>30kg/m²占55%，糖尿病占35%，当前吸烟者占5%。合并症包括冠状动脉疾病（CAD）占30%，心肌病占10%，慢性阻塞性肺疾病（COPD）占10%，肾功能不全占10%，室性心律失常占5%。在无反应者中，我们观察到以下危险因素：高胆固醇血症占38%，2型糖尿病占38%，BMI>30kg/m²占86%。合并症包括CAD占50%，心肌病占13%。
肾去神经支配术后3年，74%的患者收缩压基线下降10%。COPD、慢性肾脏病3a期、女性和高胆固醇血症等临床因素增加了有效降低血压的机会。
