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肾交感神经去神经术治疗顽固性高血压:维生素D与收缩压早期阳性反应之间的关联

Renal sympathetic denervation in resistant hypertension: The association between vitamin D and positive early response in systolic blood pressure.

作者信息

Costa Gonçalo, Delgado-Silva Joana, Monteiro Eric, Campos Diana, Gonçalves Lino

机构信息

Cardiology Department, Coimbra University and Hospital Center, Coimbra, Portugal.

Cardiology Department, Coimbra University and Hospital Center, Coimbra, Portugal; ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

出版信息

Rev Port Cardiol. 2022 Apr;41(4):311-320. doi: 10.1016/j.repc.2021.02.025. Epub 2022 Feb 28.

Abstract

AIMS AND OBJECTIVES

Vitamin D deficiency is a common finding and there is a suggested association with hypertension. Resistant hypertension is a clinical problem observed in 5-30% of hypertensive patients. Renal denervation (RDN) has been used for patients with resistant hypertension and has proven to lower blood pressure. Our primary goal was to assess the vitamin D serum concentration as a predictor of blood pressure response to RDN in highly selected patients.

METHODS

This prospective, nonrandomized, single-center study included 24 patients treated with RDN. Based on their one-year response after RDN, patients were classified as responders or non-responders at six months or at 12 months.

RESULTS

The median follow-up was 52 months (range, 14-91 months). After RDN, 17 patients (70.8%) had a reduction >5 mmHg in the mean systolic blood pressure, at the first six months of follow-up. At 12 months, 20 patients (83.3%) were responders. Vitamin D levels at baseline (15.1±4.8 vs. 24.2±8.8 ng/ml) and at six months (16.6±7.2 vs. 25±9.2 ng/ml) were lower in early non-responders compared to early responders (p=0.008), without significant variation during follow-up. Even though Vitamin D levels were lower in the total responder's group, no statistically significant differences were found (p=ns).

CONCLUSION

In patients with resistant hypertension, low vitamin D concentrations were associated with an absence of early response to RDN.

摘要

目的与目标

维生素D缺乏是一种常见现象,且有人提出其与高血压存在关联。难治性高血压是在5%至30%的高血压患者中观察到的临床问题。肾去神经支配术(RDN)已用于难治性高血压患者,并已证明可降低血压。我们的主要目标是评估血清维生素D浓度,作为高度选择的患者对RDN血压反应的预测指标。

方法

这项前瞻性、非随机、单中心研究纳入了24例接受RDN治疗的患者。根据RDN后一年的反应,患者在6个月或12个月时被分类为反应者或无反应者。

结果

中位随访时间为52个月(范围14 - 91个月)。RDN后,在随访的前6个月,17例患者(70.8%)平均收缩压降低>5 mmHg。在12个月时,20例患者(83.3%)为反应者。与早期反应者相比,早期无反应者的基线维生素D水平(15.1±4.8对24.2±8.8 ng/ml)和6个月时的维生素D水平(16.6±7.2对25±9.2 ng/ml)较低(p = 0.008),随访期间无显著变化。尽管总反应者组的维生素D水平较低,但未发现统计学上的显著差异(p = 无显著性差异)。

结论

在难治性高血压患者中,低维生素D浓度与对RDN缺乏早期反应相关。

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