Effects of Renal Sympathetic Denervation on Arterial Stiffness and Central Hemodynamics in Patients With Resistant Hypertension
Effects of Renal Sympathetic Denervation on Arterial Stiffness and Central Hemodynamics in Patients With Resistant Hypertension
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DOI：
10.1016/j.jacc.2012.08.959
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发表时间：
2012-11-06
影响因子：
24
通讯作者：
Hoppe, Uta C.
中科院分区：
文献类型：
--
作者：
Brandt, Mathias C.;Reda, Sara;Hoppe, Uta C.
目的探讨肾交感神经断导对顽固性高血压患者中枢性血流动力学的影响。背景：高中心血压（BP）会增加心血管事件和死亡率，与外周血压无关。RD对中央血压的影响尚不清楚。方法110例患者行双侧RD手术，分别在基线及消融后1、3、6个月进行桡动脉压平和脉搏波分析，得出中心主动脉压和血流动力学指标。10例未接受RD的顽固性高血压患者作为对照。结果RD组在1个月、3个月和6个月时显著降低平均主动脉中央压，分别从167/92 mm Hg降至149/88 mm Hg、147/85 mm Hg和141/85 mm Hg （p < 0.001）。RD后1、3、6个月，主动脉脉压分别从76.2 +/- 23.3 mm Hg降至61.5 +/- 17.5 mm Hg、62.7 +/- 18.1 mm Hg和54.5 +/- 15.7 mm Hg （p < 0.001）。RD后6个月主动脉增强和增强指数分别显著降低-11 mm Hg （p < 0.001）和-5.3% （p < 0.001）。颈动脉至股动脉脉波速度在6个月时从11.6 +/- 3.2 m/s显著降低至9.6 +/- 3.1 m/s （p < 0.001）。同样，射血持续时间和主动脉收缩压负荷显著降低，表明RD改善了心脏工作负荷。对照组无明显变化。结论除了已知的RD对肱血压的影响外，该研究首次表明，这种新方法可显著改善动脉僵硬度和中央血流动力学，这可能对心血管高危的顽固性高血压患者的预后具有重要意义。[J]中华医学会心脏科杂志，2012;60:56-65)(C) 2012
Objectives This study investigated the effect of catheter-based renal sympathetic denervation (RD) on central hemodynamics in patients with resistant hypertension.Background High central blood pressure (BP) increases cardiovascular events and mortality independently of peripheral BP. The effect of RD on central BP is unclear.Methods A total of 110 patients underwent bilateral RD. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressure and hemodynamic indices at baseline and 1, 3, and 6 months after ablation. Ten patients with resistant hypertension not undergoing RD served as controls.Results RD significantly reduced mean central aortic BP from 167/92 mm Hg to 149/88 mm Hg, 147/85 mm Hg, and 141/85 mm Hg at 1, 3, and 6 months (p < 0.001), respectively. Aortic pulse pressure decreased from 76.2 +/- 23.3 mm Hg to 61.5 +/- 17.5 mm Hg, 62.7 +/- 18.1 mm Hg, and 54.5 +/- 15.7 mm Hg 1, 3, and 6 months after RD (p < 0.001), respectively. Six months after RD aortic augmentation and augmentation index were significantly reduced by -11 mm Hg (p < 0.001) and -5.3% (p < 0.001), respectively. Carotid to femoral pulse wave velocity showed a significant reduction from 11.6 +/- 3.2 m/s to 9.6 +/- 3.1 m/s at 6 months (p < 0.001). Consistently, ejection duration and aortic systolic pressure load were significantly diminished, indicating improvement of cardiac work load by RD. No significant changes were obtained in control patients.Conclusions Besides the known effect of RD on brachial blood pressure, the study showed for the first time that this novel approach significantly improves arterial stiffness and central hemodynamics, which might have important prognostic implications in patients with resistant hypertension at high cardiovascular risk. (J Am Coll Cardiol 2012;60:1956-65) (C) 2012 by the American College of Cardiology Foundation