From the Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany.
Hypertension. 2019 Aug;74(2):341-348. doi: 10.1161/HYPERTENSIONAHA.119.13019. Epub 2019 Jun 17.
Patients with isolated systolic hypertension (ISH) are thought to show a diminished blood pressure (BP)-lowering effect after renal sympathetic denervation (RDN). This conclusion is mostly derived from unipolar radiofrequency catheter ablation studies. Limited data for newer RDN technologies exist. We used data from the RADIOSOUND-HTN (Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension) comparing 3 different RDN approaches to investigate a possible interaction between ISH and RDN response. One hundred twenty patients were stratified by having ISH or combined systolic-diastolic hypertension (CH). Of these, 39 underwent radiofrequency ablation of the renal main arteries, 39 combined radiofrequency ablation of the main and branch arteries, and 42 were treated with ultrasound-based ablation of the main renal artery. Patients with ISH (n=61) were older and had lower systolic and diastolic BP on ambulatory measurement (ambulatory BP measurement) at baseline in comparison to CH (n=59). At 3 months, patients with ISH showed a less pronounced BP-lowering effect of RDN as compared to patients with CH (daytime average -5.9±11.8 versus -13.3±11.7 mm Hg, P=0.001). This difference was significant for radiofrequency ablation of the renal main arteries and ultrasound-based ablation of the main renal artery treatment but did not reach significance in the radiofrequency ablation of the main and branch arteries group. After adjustment for baseline BP values and age, there was no significant difference in BP reduction between ISH and CH. Using unadjusted BP values, RDN seems to be more effective in CH than in ISH. However, adjusting for baseline BP values revealed similar BP reduction in ISH and CH patients, irrespective of the RDN treatment used. The value of ISH as predictor for successful RDN might have been overestimated in the past. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02920034.
患者孤立性收缩期高血压(ISH)被认为在肾交感神经去神经支配(RDN)后血压降低效果减弱。这一结论主要来自单极射频导管消融研究。关于较新的 RDN 技术的数据有限。我们使用来自 RADIOSOUND-HTN(三种不同肾去神经设备和技术治疗难治性高血压的随机试验)的数据,比较了 3 种不同的 RDN 方法,以研究 ISH 和 RDN 反应之间可能存在的相互作用。120 名患者按是否存在 ISH 或合并收缩期-舒张期高血压(CH)进行分层。其中,39 例行肾主要动脉射频消融术,39 例行主、支动脉射频消融联合治疗,42 例行主肾动脉超声消融治疗。与 CH(n=59)相比,ISH(n=61)患者年龄更大,且基线时动态血压测量(ambulatory BP measurement)的收缩压和舒张压更低。与 CH 患者相比,ISH 患者在 3 个月时 RDN 的降压效果较弱(日间平均-5.9±11.8 与-13.3±11.7mmHg,P=0.001)。这种差异在肾主要动脉射频消融和主肾动脉超声消融治疗中具有显著性,但在主、支动脉射频消融组中未达到显著性。在调整基线血压值和年龄后,ISH 和 CH 患者的血压降低无显著差异。使用未调整的血压值,RDN 在 CH 患者中比在 ISH 患者中更有效。然而,在调整了基线血压值后,无论使用何种 RDN 治疗,ISH 和 CH 患者的血压降低情况相似。过去,ISH 作为 RDN 成功的预测因子可能被高估了。临床试验注册- URL:http://www.clinicaltrials.gov. 独特标识符:NCT02920034。