Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, NY, USA.
Clin Res Cardiol. 2021 May;110(5):725-731. doi: 10.1007/s00392-020-01718-6. Epub 2020 Aug 1.
Catheter-based renal denervation (RDN) reduces blood pressure (BP) throughout the 24-h period, as reported in several randomized sham-controlled trials. Reduction of BP in the early morning hours is especially important due to increased cardiovascular risks during that time.
In this report, we examine the impact of RDN on systolic BP (SBP) and diastolic BP (DBP) during the critical morning surge period in a post-hoc analysis of patients in the SPYRAL HTN-ON MED trial.
Ambulatory BP measurements were collected at baseline and 6 months for treatment and control patient groups over 24-h periods. Average morning BP surge is the difference between average morning BP and average nighttime BP, and the morning surge slope reflects the rate of change of BP from nighttime to morning. Mean morning DBP surge slopes were significantly lower for RDN vs. control groups at 6 months (1.1 vs. 3.6 mmHg/h; p = 0.029). In the RDN group, morning DBP surge slopes were significantly lower at 6 months compared to baseline (1.1 vs. 4.1 mmHg/h; p = 0.006). Similar patterns were observed for mean morning SBP surge slope but did not reach statistical significance.
This decrease in the morning DBP surge slope, an index of the sympathetically-mediated morning BP surge, thus indicates a drop in late morning BP relative to early morning/nocturnal BP in the RDN group. Thus, RDN appears effective in attenuating the slope of morning surge in DBP that might indicate possible benefits in a high-risk hypertensive population.
https://www.clinicaltrials.gov (NCT02439775), registered May 12, 2015.
基于导管的肾脏去神经（RDN）可降低血压（BP），这在几项随机假对照试验中均有报道。由于在此期间心血管风险增加，因此清晨时段的血压降低尤为重要。
在 SPYRAL HTN-ON MED 试验中，我们在一项事后分析中检查了 RDN 对接受治疗和对照组患者的关键清晨高峰期间的收缩压（SBP）和舒张压（DBP）的影响。
在 24 小时期间，为治疗组和对照组患者收集了基线和 6 个月时的动态血压测量值。平均清晨 BP 高峰是平均清晨 BP 与平均夜间 BP 之间的差异，而清晨高峰斜率反映了 BP 从夜间到清晨的变化率。与对照组相比，RDN 组在 6 个月时的平均清晨 DBP 高峰斜率明显较低（1.1 与 3.6mmHg/h；p=0.029）。在 RDN 组中，与基线相比，6 个月时清晨 DBP 高峰斜率明显较低（1.1 与 4.1mmHg/h；p=0.006）。平均清晨 SBP 高峰斜率也呈现出相似的模式，但未达到统计学意义。
清晨 DBP 高峰斜率的这种降低，即交感神经介导的清晨 BP 高峰的指标，表明 RDN 组的傍晚与清晨/夜间 BP 相比，清晨 BP 下降。因此，RDN 似乎可有效降低 DBP 清晨高峰斜率，这可能表明在高危高血压人群中可能具有获益。
https://www.clinicaltrials.gov（NCT02439775），于 2015 年 5 月 12 日注册。
