Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
Blood Press. 2022 Dec;31(1):109-117. doi: 10.1080/08037051.2022.2074367.
While poor drug adherence is frequent in patients with resistant hypertension, detailed analyses of the impact of drug adherence on the success of renal denervation are scarce. We report drug adherence at baseline, changes in drug adherence, and the influence of these parameters on blood pressure changes at 6 and 12 months in patients treated with alcohol-mediated renal denervation as part of the Peregrine study.
Urinary detection of antihypertensive drugs was performed using high-performance liquid chromatography-tandem mass spectrometry. Full adherence, partial adherence, and complete non-adherence were defined as 0, 1, or ≥2 drugs not detected, respectively.
Renal denervation was performed in 45 patients with uncontrolled hypertension on ≥3 antihypertensive medications (62% men, age 55 ± 10 years). At baseline, the proportion of fully, partially, and non-adherent patients was 62% ( = 28), 16% ( = 7), and 22% ( = 10), respectively. At 6 months, adherence improved by 21% ( = 9), remained unchanged at 49% ( = 21), and worsened by 30% ( = 13). Mean 24-h systolic blood pressure decreased by 10 ± 13, 10 ± 4, and 14 ± 19 mmHg in fully, partially, and non-adherent patients ( = 0.77), and by 14 ± 14, 8 ± 11, and 14 ± 18 mmHg in patients who improved, maintained, or decreased adherence, respectively ( = 0.35). The results at 12 months were similar.
About 40% of patients with apparently treatment-resistant hypertension were not fully adherent at baseline, and adherence decreased further in 30%. Nevertheless, mean blood pressure changes after renal denervation were similar irrespective of drug adherence. Our results suggest that such patients may benefit from alcohol-mediated renal denervation, irrespective of drug adherence. These findings are hypothesis-generating and need to be confirmed in ongoing sham-controlled trials.
尽管耐药性高血压患者的药物依从性较差，但对药物依从性对肾去神经术成功的影响进行详细分析的研究却很少。我们报告了接受酒精介导的肾去神经术治疗的患者在基线时的药物依从性、药物依从性的变化，以及这些参数对 6 个月和 12 个月时血压变化的影响，这些患者是 Peregrine 研究的一部分。
使用高效液相色谱-串联质谱法检测尿液中的降压药物。完全依从、部分依从和完全不依从分别定义为未检测到 0、1 或≥2 种药物。
对 45 名服用≥3 种降压药物（62%为男性，年龄 55±10 岁）的未控制高血压患者进行了肾去神经术。基线时，完全、部分和不依从的患者比例分别为 62%（28 例）、16%（7 例）和 22%（10 例）。6 个月时，依从性提高了 21%（9 例），不变的占 49%（21 例），恶化的占 30%（13 例）。完全、部分和不依从的患者平均 24 小时收缩压分别降低了 10±13、10±4 和 14±19mmHg（ = 0.77），依从性改善、保持和下降的患者分别降低了 14±14、8±11 和 14±18mmHg（ = 0.35）。12 个月时的结果相似。
约 40%的药物难治性高血压患者基线时未完全依从，30%的患者依从性进一步下降。然而，肾去神经术后的平均血压变化与药物依从性无关。我们的结果表明，即使药物依从性较差，此类患者也可能从酒精介导的肾去神经术获益。这些发现是产生假设的，需要在正在进行的假手术对照试验中得到证实。
