Department of Nephrology & Rheumatology, University Medical Centre, Göttingen, Germany.
Department of Hematology & Oncology, University Medical Centre, Göttingen, Germany.
J Clin Hypertens (Greenwich). 2021 Jul;23(7):1363-1371. doi: 10.1111/jch.14302. Epub 2021 Jun 8.
Uncontrolled hypertension is a main risk factor for cardiovascular morbidity. Baroreflex activation therapy (BAT) is an effective therapy option addressing true resistant hypertension. We evaluated patients' eligibility for BAT in a staged assessment as well as adherence to antihypertensive drug therapy. Therefore, we analyzed files of 345 patients, attending the hypertension clinic at University Medicine Göttingen. Additionally, gas chromatographic-mass spectrometric urine analyses of selected individuals were performed evaluating their adherence. Most common cause for a revoked BAT recommendation was blood pressure (BP) control by drug adjustment (54.2%). Second leading cause was presence of secondary hypertension (31.6%). Patients to whom BAT was recommended (59 (17.1%)) were significantly more often male (67.8% vs. 43.3%, P = .0063), had a higher body mass index (31.8 ± 5.8 vs. 30.0 ± 5.7 kg/m², P = .0436), a higher systolic office (168.7 ± 24.7 vs. 147.7 ± 24.1 mmHg, P < .0001), and 24h ambulatory BP (155.0 ± 14.6 vs. 144.4 ± 16.8 mmHg, P = .0031), took more antihypertensive drugs (5.8 ± 1.3 vs. 4.4 ± 1.4, P < .0001), and suffered more often from numerous concomitant diseases. Eventually, 27 (7.8%) received a BAT system. In the toxicological analysis of 75 patients, mean adherence was 75.1%. 16 patients (21.3%) showed non-adherence. Thus, only a small number of patients eventually received a BAT system, as treatable reasons for apparently resistant hypertension could be identified frequently. This study is-to our knowledge-the first report of a staged assessment of patients' suitability for BAT and underlines the need for a careful examination and indication. Non-adherence was proven to be a relevant issue concerning apparently resistant hypertension and therefore non-eligibility for interventional antihypertensive therapy.
未控制的高血压是心血管发病率的主要危险因素。压力感受性反射激活治疗（BAT）是一种有效的治疗选择，可针对真正的难治性高血压。我们在分期评估中评估了 345 名患者接受 BAT 的资格，并评估了他们对降压药物治疗的依从性。因此，我们分析了在哥廷根大学医学中心高血压诊所就诊的 345 名患者的档案。此外，对选定的个体进行了气相色谱-质谱尿液分析，以评估他们的依从性。取消 BAT 推荐的最常见原因是药物调整控制血压（54.2%）。第二个主要原因是存在继发性高血压（31.6%）。被推荐接受 BAT 的患者（59 例（17.1%））显著更常为男性（67.8%比 43.3%，P=0.0063），体重指数更高（31.8±5.8 比 30.0±5.7kg/m²，P=0.0436），诊室收缩压更高（168.7±24.7 比 147.7±24.1mmHg，P<0.0001），24 小时动态血压更高（155.0±14.6 比 144.4±16.8mmHg，P=0.0031），服用更多的降压药（5.8±1.3 比 4.4±1.4，P<0.0001），并且经常患有多种合并症。最终，27 名（7.8%）患者接受了 BAT 系统。在 75 名患者的毒理学分析中，平均依从率为 75.1%。16 名患者（21.3%）表现出不依从。因此，只有少数患者最终接受了 BAT 系统，因为经常可以确定明显难治性高血压的可治疗原因。这项研究是 - 据我们所知 - 第一个关于患者接受 BAT 资格的分期评估的报告，并强调了仔细检查和指示的必要性。不依从性被证明是与明显难治性高血压相关的一个重要问题，因此不符合介入性降压治疗的条件。
