Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
St. Josefs Hospital, Cloppenburg, Germany.
Clin Res Cardiol. 2019 Nov;108(11):1287-1296. doi: 10.1007/s00392-019-01464-4. Epub 2019 Apr 6.
Activation of the sympathetic nervous system increases sodium retention in resistant hypertension. Baroreflex activation therapy (BAT) is an interventional method to reduce sympathetic overactivity in patients with resistant hypertension. This study aimed to assess the effect of BAT on urinary sodium excretion.
From 2012 to 2015, consecutive patients with resistant hypertension and blood pressure (BP) above target despite polypharmacy strategies were consecutively included in this observational study. BAT was provided with the individual adaption of programmed parameters over the first months. 24-h urinary sodium excretion (UNa) was estimated at baseline and after 6 months using the Kawasaki formula in patients undergoing BAT. Additionally, the fractional sodium excretion, plasma renin activity, and aldosterone levels were assessed.
Forty-two patients completed the 6-month follow-up period. Office systolic and ambulatory 24-h systolic BP at baseline were 169 ± 27 mmHg and 148 ± 16 mmHg despite a median intake of 7(3-9) antihypertensive drugs. After 6 months of BAT, systolic office BP decreased to 150 ± 29 mmHg (p < 0.01), 24-h systolic BP to 142 ± 22 mmHg (p = 0.04) and 24-h UNa increased by 37% compared to baseline (128 ± 66 vs. 155 ± 83 mmol/day, p < 0.01). These findings were accompanied by a significant increase in fractional sodium excretion (0.74% [0.43-1.47] to 0.92% [0.61-1.92]; p = 0.02). However, in contrast to the significant BP reduction, eGFR, plasma sodium, renin activity and aldosterone levels did not change during BAT. The increase in sodium excretion was correlated with the change in eGFR (r = 0.371; p = 0.015).
The present study revealed a significant increase of estimated 24-h UNa which may contribute to the long-term BP-lowering effects of this interventional method.
交感神经系统的激活会导致抗药性高血压患者的钠潴留增加。压力反射激活疗法（BAT）是一种降低抗药性高血压患者交感神经活性的介入方法。本研究旨在评估 BAT 对尿钠排泄的影响。
从 2012 年到 2015 年，连续纳入患有抗药性高血压且尽管采用多药治疗策略血压仍高于目标的患者进行这项观察性研究。在最初的几个月内，通过个体化调整程控参数为患者提供 BAT。在接受 BAT 的患者中，使用川崎公式在基线和 6 个月时估计 24 小时尿钠排泄量（UNa）。此外，还评估了钠排泄分数、血浆肾素活性和醛固酮水平。
42 例患者完成了 6 个月的随访。基线时，诊室收缩压和动态 24 小时收缩压分别为 169 ± 27mmHg 和 148 ± 16mmHg，尽管中位数抗高血压药物的使用量为 7（3-9）种。BAT 治疗 6 个月后，诊室收缩压下降至 150 ± 29mmHg（p < 0.01），24 小时收缩压下降至 142 ± 22mmHg（p = 0.04），与基线相比，24 小时 UNa 增加 37%（128 ± 66 与 155 ± 83mmol/天，p < 0.01）。这些发现伴随着钠排泄分数的显著增加（0.74%[0.43-1.47]至 0.92%[0.61-1.92]；p = 0.02）。然而，与显著的血压降低相比，eGFR、血浆钠、肾素活性和醛固酮水平在 BAT 期间没有变化。钠排泄的增加与 eGFR 的变化相关（r = 0.371；p = 0.015）。
本研究显示 24 小时 UNa 估计值显著增加，这可能有助于该介入方法的长期降压效果。
