Wu Fengyuan, Yuan Xiaoyang, Sun Kaiwen, Zhang Ying, Zhu Lianxin, Bai Cuiping, Cheng Yunpeng, Lu Yan, Jiang Yinong, Song Wei
Department of Cardiology First Affiliated Hospital of Dalian Medical University Dalian Liaoning China.
Department of Clinical Laboratory First Affiliated Hospital of Dalian Medical University Dalian Liaoning China.
J Am Heart Assoc. 2024 Feb 20;13(4):e030427. doi: 10.1161/JAHA.123.030427. Epub 2024 Feb 13.
This case-control study aimed to determine whether there were differences between patients with essential hypertension with accessory renal arteries (ARAs) and those without ARAs.
The enrolled patients with essential hypertension were divided into the ARA group (n=200) and control group without ARAs (n=238). After propensity matching, 394 patients (197 in each of the 2 groups), were included. The 24-hour BP (4.33/2.43 mm Hg) and daytime BP (4.48/2.61 mm Hg) of patients in the ARA group were significantly higher than those of the control group (<0.05). The flow-mediated dilation was lower in the ARA group (5.98±2.70 versus 5.18±2.66; <0.05). In correlation analysis, the horizontal plasma aldosterone concentration had the highest correlation with 24-hour, daytime, and nighttime systolic BP (=0.263, 0.247, and 0.243, respectively; <0.05) and diastolic BP (=0.325, 0.298, and 0.317, respectively; <0.05). As for multivariate regression analysis, plasma aldosterone concentration was a significant risk factor for elevated 24-hour, daytime, and nighttime systolic BP (β=0.249 [95% CI, 0.150-0.349], 0.228 [95% CI, 0.128-0.329], and 0.282 [95% CI, 0.187-0.377], respectively; <0.05) and elevated diastolic BP (β=0.289 [95% CI, 0.192-0.385], 0.256 [95% CI, 0.158-0.353], and 0.335 [95% CI, 0.243-0.427], respectively; <0.05). Direct renin concentration was also a risk factor for 24-hour and daytime BPs, whereas heart rate was a risk factor correlated with 24-hour, daytime, and nighttime diastolic BP (all <0.05). For the mixed-effects model for repeated measures, the results were similar to results of the multivariate regression analysis (all <0.05).
ARAs could contribute a higher BP of patients with essential hypertension and might promote the development of essential hypertension. The mechanism might be related to overactivation of the renin-angiotensin-aldosterone system and sympathetic nervous system.
本病例对照研究旨在确定原发性高血压合并副肾动脉（ARA）的患者与不合并ARA的患者之间是否存在差异。
纳入的原发性高血压患者被分为ARA组（n = 200）和无ARA的对照组（n = 238）。经过倾向得分匹配后，纳入了394例患者（两组各197例）。ARA组患者的24小时血压（4.33/2.43 mmHg）和日间血压（4.48/2.61 mmHg）显著高于对照组（P<0.05）。ARA组的血流介导的血管舒张功能较低（5.98±2.70对5.18±2.66；P<0.05）。在相关性分析中，血浆醛固酮浓度与24小时、日间和夜间收缩压的相关性最高（分别为r = 0.263、0.247和0.243；P<0.05）以及舒张压（分别为r = 0.325、0.298和0.317；P<0.05）。在多变量回归分析中，血浆醛固酮浓度是24小时、日间和夜间收缩压升高的显著危险因素（β分别为0.249 [95%CI，0.150 - 0.349]、0.228 [95%CI，0.128 - 0.329]和0.282 [95%CI，0.187 - 0.377]；P<0.05）以及舒张压升高的危险因素（β分别为0.289 [95%CI，0.192 - 0.385]、0.256 [95%CI，0.158 - 0.353]和0.335 [95%CI，0.243 - 0.427]；P<0.05）。直接肾素浓度也是24小时和日间血压的危险因素，而心率是与24小时、日间和夜间舒张压相关的危险因素（均P<0.05）。对于重复测量的混合效应模型，结果与多变量回归分析的结果相似（均P<0.05）。
ARA可能导致原发性高血压患者血压升高，并可能促进原发性高血压的发展。其机制可能与肾素 - 血管紧张素 - 醛固酮系统和交感神经系统的过度激活有关。
