Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA.
J Hypertens. 2022 Feb 1;40(2):221-228. doi: 10.1097/HJH.0000000000002994.
The RADIANCE-HTN SOLO trial demonstrated a greater reduction in daytime ambulatory SBP at 2 months by endovascular ultrasound renal denervation than sham procedure. We hypothesized that plasma renin and aldosterone concentrations would be associated with the SBP response to renal denervation.
Hypertensive patients were randomized to renal denervation (n = 74) or sham (n = 72) after a 4-week washout of antihypertensive medications. In a 53-patient subset, 2-month and 6-month plasma renin and aldosterone concentration were measured. Dietary sodium was not controlled.
Mean age of the 29 treatment and 24 sham patients was 54 years; 62% were men; 17% black. Daytime ambulatory SBP fell in the denervation but not the sham group at 2 months (-7.8 ± 10.7 vs. -0.1 ± 10.1 mmHg; P = 0.048). Baseline plasma renin and aldosterone concentrations were in the low-normal range, did not change significantly at 2 months in either group and did not predict response to renal denervation. At 6 months, after the addition of antihypertensive medications, there was a significant rise in renin in the sham but not the denervation group.
Although renal denervation but not sham resulted in a decrease in daytime ambulatory SBP at 2 months, renin and aldosterone concentrations did neither predict the BP response to renal denervation; nor did they fall after denervation. A rise in renin at 6 months in the sham group likely represents confounding from antihypertensive medications. Whether the BP-lowering effect of renal denervation depends on reducing local intrarenal renin release requires further study.
RADIANCE-HTN SOLO 试验表明，与假手术相比，血管内超声肾动脉去神经术在 2 个月时可更大程度地降低日间动态收缩压。我们假设血浆肾素和醛固酮浓度与肾去神经术的血压反应有关。
在停止使用降压药物 4 周后，高血压患者被随机分为肾去神经组（n = 74）或假手术组（n = 72）。在一个 53 例患者的亚组中，测量了 2 个月和 6 个月时的血浆肾素和醛固酮浓度。未控制饮食中的钠含量。
29 例治疗组和 24 例假手术组患者的平均年龄为 54 岁；62%为男性；17%为黑人。在 2 个月时，去神经组的日间动态收缩压下降，但假手术组没有（-7.8 ± 10.7 与-0.1 ± 10.1 毫米汞柱；P = 0.048）。基线时血浆肾素和醛固酮浓度处于低正常范围，两组在 2 个月时均无明显变化，也不能预测肾去神经术的反应。6 个月时，在添加降压药物后，假手术组肾素显著升高，但去神经组没有。
尽管肾去神经术而非假手术在 2 个月时可降低日间动态收缩压，但肾素和醛固酮浓度既不能预测肾去神经术的血压反应；也不会在去神经术后下降。假手术组在 6 个月时肾素升高可能是降压药物引起的混杂因素。肾去神经术的降压作用是否取决于减少局部肾内肾素释放，需要进一步研究。
