Integrative Blood Pressure Response to Upright Tilt Post Renal Denervation.
Integrative Blood Pressure Response to Upright Tilt Post Renal Denervation.
复制标题
肾去神经支配后直立倾斜的综合血压反应。
DOI：
10.1093/ajh/hpx018
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发表时间：
2017
影响因子：
3.2
通讯作者：
Levine,BenjaminD
中科院分区：
文献类型：
--
作者：
Howden,ErinJ;East,Cara;Lawley,JustinS;Stickford,AbigailSL;Verhees,Myrthe;Fu,Qi;Levine,BenjaminD
研究背景顽固性高血压患者的肾脏去神经支配（RDN）是否能使血压（BP）调节正常化，以响应常规的心血管刺激，如直立姿势，目前尚不清楚。我们进行了一项综合性研究的血压调节顽固性高血压患者接受RDN的自主循环control.METHODSTwelve患者（60 ± 9 [SD]岁，n= 10名男性）参加了Symplicity HTN-3试验进行了研究，并比较了2个年龄匹配的正常血压（Norm）和高血压（未用药，HTN）对照组。血压，心率（HR），心输出量（Qc），肌肉交感神经活动（MSNA），和神经激素变量测量仰卧位，30°（5分钟）和60°（20分钟）头高位倾斜（HUT）。根据平均动脉压和Qc计算总外周阻力（TPR）。尽管使用RDN和4.8（范围，3-7）种抗高血压药物治疗，RDN患者的仰卧位收缩压仍显著高于正常和HTN患者（149 ± 15 vs. 118 ± 6，108 ± 8 mm Hg，P< 0.001）。当仰卧位时，RDN的HR、TPR、MSNA、血浆去甲肾上腺素和有效动脉弹性均高于正常人。RDN组的血浆去甲肾上腺素、Qc和HR也高于HTN组。在HUT，BP仍然较高的RDN，由于增加Qc，血浆去甲肾上腺素，和aldosterone. CONCLUSION我们提供的证据，一个可能的机制，BP仍然升高后RDN，增加Qc和动脉僵硬度的观察，以及血浆去甲肾上腺素和醛固酮水平在大约2年后治疗。这些发现可能是交感肾神经消融不完全的结果，也可能与其他因素有关。
BACKGROUNDWhether renal denervation (RDN) in patients with resistant hypertension normalizes blood pressure (BP) regulation in response to routine cardiovascular stimuli such as upright posture is unknown. We conducted an integrative study of BP regulation in patients with resistant hypertension who had received RDN to characterize autonomic circulatory control.METHODSTwelve patients (60 ± 9 [SD] years,n= 10 males) who participated in the Symplicity HTN-3 trial were studied and compared to 2 age-matched normotensive (Norm) and hypertensive (unmedicated, HTN) control groups. BP, heart rate (HR), cardiac output (Qc), muscle sympathetic nerve activity (MSNA), and neurohormonal variables were measured supine, and 30° (5 minutes) and 60° (20 minutes) head-up-tilt (HUT). Total peripheral resistance (TPR) was calculated from mean arterial pressure and Qc.RESULTSDespite treatment with RDN and 4.8 (range, 3–7) antihypertensive medications, the RDN had significantly higher supine systolic BP compared to Norm and HTN (149 ± 15 vs. 118 ± 6, 108 ± 8 mm Hg,P< 0.001). When supine, RDN had higher HR, TPR, MSNA, plasma norepinephrine, and effective arterial elastance compared to Norm. Plasma norepinephrine, Qc, and HR were also higher in the RDN vs. HTN. During HUT, BP remained higher in the RDN, due to increases in Qc, plasma norepinephrine, and aldosterone.CONCLUSIONWe provide evidence of a possible mechanism by which BP remains elevated post RDN, with the observation of increased Qc and arterial stiffness, as well as plasma norepinephrine and aldosterone levels at approximately 2 years post treatment. These findings may be the consequence of incomplete ablation of sympathetic renal nerves or be related to other factors.