Department of Cardiology.
Department of Internal and Vascular Medicine, Erasmus University Medical Center, Rotterdam.
J Hypertens. 2023 Mar 1;41(3):476-485. doi: 10.1097/HJH.0000000000003361. Epub 2023 Jan 19.
Renal sympathetic denervation (RDN) reduces blood pressure (BP). However, one out of three patients does not exhibit a significant BP response to the therapy. This study investigates the association between noninvasive vascular stiffness indices and RDN-mediated BP reduction.
In this prospective, single-arm pilot study, patients with systolic office BP at least 140 mmHg, mean 24-h systolic ambulatory blood pressure (ABP) at least 130 mmHg and at least three prescribed antihypertensive drugs underwent radiofrequency RDN. The primary efficacy endpoint was temporal evolution of mean 24-h systolic ABP throughout 1-year post RDN (measured at baseline and 3-6-12 months). Effect modification was studied for baseline ultrasound carotid-femoral and magnetic resonance (MR) pulse wave velocity (PWV), MR aortic distensibility, cardiac MR left ventricular parameters and clinical variables. Statistical analyses were performed using linear mixed-effects models, and effect modification was assessed using interaction terms.
Thirty patients (mean age 62.5 ± 10.7 years, 50% women) with mean 24-h ABP 146.7/80.8 ± 13.7/12.0 mmHg were enrolled. Following RDN, mean 24-h systolic ABP changed with -8.4 (95% CI: -14.5 to -2.3) mmHg/year ( P = 0.007). Independent effect modifiers were CF-PWV [+2.7 (0.3 to 5.1) mmHg/year change in outcome for every m/s increase in CF-PWV; P = 0.03], daytime diastolic ABP [-0.4 (-0.8 to 0.0) mmHg/year per mmHg; P = 0.03], age [+0.6 (0.2 to 1.0) mmHg/year per year of age; P = 0.006], female sex [-14.0 (-23.1 to -5.0) mmHg/year as compared with men; P = 0.003] and BMI [+1.2 (0.1 to 2.2) mmHg/year per kg/m 2 ; P = 0.04].
Higher CF-PWV at baseline was associated with a smaller reduction in systolic ABP following RDN. These findings could contribute to improve identification of RDN responders.
肾脏去交感神经术（RDN）可降低血压（BP）。然而，三分之一的患者对该治疗无显著的血压反应。本研究旨在探讨非侵入性血管僵硬指数与 RDN 介导的 BP 降低之间的关系。
这是一项前瞻性、单臂的初步研究，纳入收缩压办公室血压至少 140mmHg、平均 24 小时收缩压动态血压至少 130mmHg 和至少三种规定降压药物的患者行射频 RDN。主要疗效终点是 RDN 后 1 年期间平均 24 小时收缩压动态血压的时间演变（基线和 3-6-12 个月测量）。研究了基线超声颈动脉-股动脉脉搏波速度（CF-PWV）和磁共振（MR）脉搏波速度、MR 主动脉顺应性、心脏磁共振左心室参数和临床变量的影响修饰。使用线性混合效应模型进行统计分析，并使用交互项评估影响修饰。
30 名患者（平均年龄 62.5±10.7 岁，50%为女性），平均 24 小时 ABP 为 146.7/80.8±13.7/12.0mmHg。RDN 后，平均 24 小时收缩压降低 -8.4（95%CI：-14.5 至-2.3）mmHg/年（P=0.007）。独立的影响修饰因子是 CF-PWV[每增加 1m/s，CF-PWV 增加 2.7（0.3 至 5.1）mmHg/年；P=0.03]、白天舒张压[每增加 1mmHg，收缩压降低 0.4（0.8 至 0.0）mmHg/年；P=0.03]、年龄[每增加 1 岁，收缩压增加 0.6（0.2 至 1.0）mmHg/年；P=0.006]、女性[与男性相比，收缩压降低 14.0（-23.1 至-5.0）mmHg/年；P=0.003]和 BMI[每增加 1kg/m2，收缩压增加 1.2（0.1 至 2.2）mmHg/年；P=0.04]。
基线时较高的 CF-PWV 与 RDN 后收缩压降低幅度较小相关。这些发现可能有助于提高 RDN 应答者的识别能力。
