Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Italy.
Istituto Auxologico Italiano, Milan, Italy.
Clin Auton Res. 2023 Apr;33(2):93-100. doi: 10.1007/s10286-023-00927-z. Epub 2023 Jan 25.
Renal denervation (RDN) exerts sympathoinhibitory effects. No information is available, however, on whether these effects have a regional or a more generalized behavior.
In 14 patients with resistant hypertension (RHT, age 58.3 ± 2.2 years, mean ± SEM), we recorded muscle and skin sympathetic nerve traffic (MSNA and SSNA, respectively) using the microneurographic technique, before, 1 month, and 3 months after RDN. Measurements included clinic blood pressure (BP), heart rate (HR), 24-h BP and HR, as well as routine laboratory and echocardiographic variables. Ten age-matched RHT patients who did not undergo RDN served as controls.
MSNA, but not SSNA, was markedly higher in RHT. RDN caused a significant reduction in MSNA 1 month after RDN, with this reduction increasing after 3 months (from 68.1 ± 2.5 to 64.8 ± 2.4 and 63.1 ± 2.6 bursts/100 heartbeats, P < 0.05). This effect was not accompanied by any significant change in SSNA (from 13.1 ± 0.5 to 13.4 ± 0.6 and 13.3 ± 0.4 bursts/min, P = NS). No quantitative or, in some cases, qualitative relationship was found between BP and the MSNA reduction induced by RDN. No significant changes in various sympathetic markers were detected in the control group who did not undergo RDN and were followed for 3-months observation.
These data provide the first evidence that RDN exerts heterogeneous effects on sympathetic cardiovascular drive, inducing a marked reduction in MSNA but not in SSNA, which appears to be within the normal range in this condition.These effects may depend on the different reflex modulation regulating neuroadrenergic drive in these cardiovascular districts.
肾脏去神经支配（RDN）可发挥抑制交感神经的作用。然而，目前尚不清楚这些作用是具有区域性还是更广泛的行为。
在 14 例患有难治性高血压（RHT，年龄 58.3±2.2 岁，均值±SEM）的患者中，我们使用微神经记录技术记录肌肉和皮肤交感神经传出活动（MSNA 和 SSNA），分别在 RDN 前、1 个月和 3 个月后进行测量。测量包括诊所血压（BP）、心率（HR）、24 小时 BP 和 HR 以及常规实验室和超声心动图变量。10 例年龄匹配的未接受 RDN 的 RHT 患者作为对照组。
RHT 患者的 MSNA 明显更高，但 SSNA 无明显升高。RDN 可显著降低 RDN 后 1 个月的 MSNA，且 3 个月后降低更明显（从 68.1±2.5 降至 64.8±2.4 和 63.1±2.6 个/100 次心跳，P<0.05）。这一效应并未伴有 SSNA 的任何显著变化（从 13.1±0.5 增加至 13.4±0.6 和 13.3±0.4 个/分钟，P=NS）。在未接受 RDN 并接受 3 个月观察的对照组中，未发现 BP 与 RDN 引起的 MSNA 降低之间存在定量或某些情况下的定性关系。
这些数据首次提供证据表明，RDN 对交感心血管驱动产生异质性影响，导致 MSNA 明显降低，但 SSNA 无明显降低，在这种情况下 SSNA 似乎处于正常范围内。这些效应可能取决于调节这些心血管区域神经肾上腺素能驱动的不同反射调节。
