Department of Nephrology and Hypertension Dokkyo Medical University Tochigi Japan.
Division of Hypertension and Nephrology National Cerebral and Cardiovascular Center Osaka Japan.
J Am Heart Assoc. 2022 Mar 15;11(6):e023655. doi: 10.1161/JAHA.121.023655. Epub 2022 Mar 9.
Background We investigated the early postoperative effect of percutaneous transluminal renal angioplasty on ambulatory blood pressure (BP) and the circadian characteristics of natriuresis and autonomic nerve activity. Methods and Results A total of 64 patients with hypertension with hemodynamically significant renal artery stenosis (mean age, 60.0±21.0 years; 31.3% fibromuscular dysplasia) who underwent angioplasty were included, and circadian characteristics of natriuresis as well as heart rate variability indices, including 24-hour BP, low-frequency and high-frequency (HF) components, and the percentage of differences between adjacent normal R-R intervals >50 ms were evaluated using an oscillometric device, TM-2425, both at baseline and 3 days after angioplasty. In both the fibromuscular dysplasia and atherosclerotic stenosis groups, 24-hour systolic BP (fibromuscular dysplasia, -19±14; atherosclerotic renal artery stenosis, -11±9 mm Hg), percentage of differences between adjacent normal R-R intervals >50 ms, HF, brain natriuretic peptide, and nighttime urinary sodium excretion decreased (all <0.01), and heart rate increased (both <0.05) after angioplasty. In both groups, revascularization increased the night/day ratios of percentage of differences between adjacent normal R-R intervals >50 ms (both <0.01) and HF, and decreased those of low frequency/HF (all <0.05) and nighttime urinary sodium excretion (fibromuscular dysplasia, 1.17±0.15 to 0.78±0.09; atherosclerotic renal artery stenosis, 1.37±0.10 to 0.99±0.06, both <0.01). Multiple logistic regression analysis indicated that a 1-SD increase in baseline low frequency/HF was associated with at least a 15% decrease in 24-hour systolic BP after angioplasty (odds ratio, 2.30 [95% CI, 1.03-5.67]; <0.05). Conclusions Successful revascularization results in a significant BP decrease in the early postoperative period. Intrarenal perfusion might be a key modulator of the circadian patterns of autonomic nerve activity and natriuresis, and pretreatment heart rate variability evaluation seems to be important for treatment success.
我们研究了经皮腔内肾血管成形术对动态血压（BP）和利钠及自主神经活动昼夜节律特征的早期术后影响。
共纳入 64 例患有高血压且伴血流动力学显著肾动脉狭窄的患者（平均年龄 60.0±21.0 岁；31.3%为纤维肌性发育不良），使用示波法装置 TM-2425 在基线和血管成形术后 3 天评估利钠的昼夜节律特征以及心率变异性指数，包括 24 小时 BP、低频和高频（HF）成分以及相邻正常 R-R 间期差值>50 ms 的百分比。在纤维肌性发育不良和动脉粥样硬化性狭窄组中，24 小时收缩压（纤维肌性发育不良，-19±14；动脉粥样硬化性肾动脉狭窄，-11±9 mmHg）、相邻正常 R-R 间期差值>50 ms 的百分比、HF、脑利钠肽和夜间尿钠排泄均降低（均<0.01），心率增加（均<0.05）。两组血管再通后，相邻正常 R-R 间期差值>50 ms 的夜间/日间比值（均<0.01）和 HF 增加，低频/HF 比值（均<0.05）和夜间尿钠排泄减少（纤维肌性发育不良，1.17±0.15 至 0.78±0.09；动脉粥样硬化性肾动脉狭窄，1.37±0.10 至 0.99±0.06，均<0.01）。多变量逻辑回归分析表明，基线时低频/HF 每增加 1 个标准差，血管成形术后 24 小时收缩压至少降低 15%（比值比，2.30[95%可信区间，1.03-5.67]；<0.05）。
成功的血管再通可导致术后早期血压显著下降。肾内灌注可能是自主神经活动和利钠昼夜节律模式的关键调节因子，治疗前心率变异性评估对治疗成功似乎很重要。
