Department of Nephrology and Rheumatology, University Medical Centre, Göttingen, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany.
ESC Heart Fail. 2024 Oct;11(5):3360-3367. doi: 10.1002/ehf2.14940. Epub 2024 Jul 5.
Arterial hypertension (aHTN) plays a fundamental role in the pathogenesis and prognosis of heart failure with preserved ejection fraction (HFpEF). The risk of heart failure increases with therapy-resistant arterial hypertension (trHTN), defined as inadequate blood pressure (BP) control ≥140/90 mmHg despite taking ≥3 antihypertensive medications including a diuretic. This study investigates the effects of the BP lowering baroreflex activation therapy (BAT) on cardiac function and morphology in patients with trHTN with and without HFpEF.
Sixty-four consecutive patients who had been diagnosed with trHTN and received BAT implantation between 2012 and 2016 were prospectively observed. Office BP, electrocardiographic and echocardiographic data were collected before and after BAT implantation.
Mean patients' age was 59.1 years, 46.9% were male, and mean body mass index (BMI) was 33.2 kg/m. The prevalence of diabetes mellitus was 38.8%, atrial fibrillation was 12.2%, and chronic kidney disease (CKD) stage ≥3 was 40.8%. Twenty-eight patients had trHTN with HFpEF, and 21 patients had trHTN without HFpEF. Patients with HFpEF were significantly older (64.7 vs. 51.6 years, P < 0.0001), had a lower BMI (30.0 vs. 37.2 kg/m, P < 0.0001), and suffered more often from CKD-stage ≥3 (64 vs. 20%, P = 0.0032). After BAT implantation, mean office BP dropped in patients with and without HFpEF (from 169 ± 5/86 ± 4 to 143 ± 4/77 ± 3 mmHg [P = 0.0019 for systolic BP and 0.0403 for diastolic BP] and from 170 ± 5/95 ± 4 to 149 ± 6/88 ± 5 mmHg [P = 0.0019 for systolic BP and 0.0763 for diastolic BP]), while a significant reduction of the intake of calcium-antagonists, α-agonists and direct vasodilators, as well as a decrease in average dosage of ACE-inhibitors and α-agonists could be seen. Within the study population, a decrease in heart rate from 74 ± 2 to 67 ± 2 min (P = 0.0062) and lengthening of QRS-time from 96 ± 3 to 106 ± 4 ms (P = 0.0027) and QTc-duration from 422 ± 5 to 432 ± 5 ms (P = 0.0184) were detectable. The PQ duration was virtually unchanged. In patients without HF, no significant changes of echocardiographic parameters could be seen. In patients with HFpEF, posterior wall diameter decreased significantly from 14.0 ± 0.5 to 12.7 ± 0.3 mm (P = 0.0125), left ventricular mass (LVM) declined from 278.1 ± 15.8 to 243.9 ± 13.4 g (P = 0.0203), and e' lateral increased from 8.2 ± 0.4 to 9.0 ± 0.4 cm/s (P = 0.0471).
BAT reduced systolic and diastolic BP and was associated with morphological and functional improvement of HFpEF.
动脉高血压（aHTN）在心衰伴射血分数保留（HFpEF）的发病机制和预后中起着重要作用。随着治疗抵抗性动脉高血压（trHTN）的出现，心力衰竭的风险增加，trHTN 定义为尽管服用了≥3 种降压药物（包括利尿剂），血压（BP）控制仍不理想（≥140/90mmHg）。本研究调查了降低血压的压力反射激活治疗（BAT）对伴有和不伴有 HFpEF 的 trHTN 患者心功能和形态的影响。
前瞻性观察 2012 年至 2016 年间诊断为 trHTN 并接受 BAT 植入的 64 例连续患者。植入前和植入后收集诊室血压、心电图和超声心动图数据。
患者平均年龄为 59.1 岁，46.9%为男性，平均体重指数（BMI）为 33.2kg/m。糖尿病患病率为 38.8%，心房颤动为 12.2%，慢性肾脏病（CKD）≥3 期为 40.8%。28 例患者伴有 HFpEF 的 trHTN，21 例患者伴有不伴 HFpEF 的 trHTN。HFpEF 患者明显年龄较大（64.7 岁比 51.6 岁，P<0.0001），BMI 较低（30.0 千克/米比 37.2 千克/米，P<0.0001），CKD 更常见≥3 期（64%比 20%，P=0.0032）。植入 BAT 后，伴或不伴 HFpEF 的患者诊室 BP 均值均下降（从 169±5/86±4mmHg 降至 143±4/77±3mmHg[P=0.0019 收缩压和 0.0403 舒张压]和从 170±5/95±4mmHg 降至 149±6/88±5mmHg[P=0.0019 收缩压和 0.0763 舒张压]），而钙拮抗剂、α 激动剂和直接血管扩张剂的摄入量显著减少，ACE 抑制剂和α 激动剂的平均剂量也降低。在研究人群中，心率从 74±2 次/分降至 67±2 次/分（P=0.0062），QRS 时间从 96±3 毫秒延长至 106±4 毫秒（P=0.0027），QTc 持续时间从 422±5 毫秒延长至 432±5 毫秒（P=0.0184）。PQ 间期基本不变。在无 HF 的患者中，超声心动图参数无明显变化。在伴有 HFpEF 的患者中，后室壁直径从 14.0±0.5 毫米显著下降至 12.7±0.3 毫米（P=0.0125），左心室质量（LVM）从 278.1±15.8 克降至 243.9±13.4 克（P=0.0203），e'侧从 8.2±0.4 厘米/秒增加至 9.0±0.4 厘米/秒（P=0.0471）。
BAT 降低了收缩压和舒张压，并与 HFpEF 的形态和功能改善相关。
