The effect of renal denervation in moderate treatment-resistant hypertension with confirmed medication adherence
The effect of renal denervation in moderate treatment-resistant hypertension with confirmed medication adherence
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DOI：
10.1097/hjh.0000000000001110
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发表时间：
2016-12-01
影响因子：
4.9
通讯作者：
Schmieder, Roland E.
中科院分区：
文献类型：
--
作者：
Ott, Christian;Mahfoud, Felix;Schmieder, Roland E.
目的：关于去肾神经对中度难治性高血压(TRH)患者降压作用的研究资料有限。此外，作为BP反应的一个潜在混杂因素，依从性的变化在这组患者中从未得到严格的分析。W(E)分析了回顾发现完全依从性降压药物的中度TRH患者的RDN对血压的影响。方法：我们的研究队列包括40名接受导管RDN的中度TRH患者[办公室BP和GT；=140/90但=130/80 mm Hg]。进一步的主要纳入标准是在基线(通过回顾毒理学评估)完全遵守他们的药物(=80%的处方抗高血压药物的摄入量)。结果：在RDN6个月后，办公室血压降低了-10/-6 mm Hg(SBP：149±/-6 vs.139+/-15 mm Hg；DBP：81+/-12 vs.75+/-10 mm Hg；P<；0.001)和24小时ABPM降低-7/-4 mm Hg(SBP：150+/-14 vs.143+/-16 mm Hg，P=0.005；舒张压：82+/-10对78+/-9毫米汞柱，P=0.009)。6个月后，降压药物的处方数量[6.0vs.5.5vs.5.5vs.5.5vs.5.5vs.91.7+/-13.9%，P=0.065]和依从率(95.2+/-7.6vs.91.7+/-13.9%，P=0.065)略有下降，两者都可能低估了真正的降压效果。结论：我们的数据表明，即使充分考虑药物依从性作为RDN术后血压反应的潜在混杂因素，中度TRH患者的办公室和24hABPM也显著减少。
Objectives: Data on the blood pressure (BP)-lowering effect of renal denervation (RDN) in moderate treatment-resistant hypertension (TRH) are limited. Moreover, change of adherence to medication, as one potential confounder of BP response, has never been analyzed rigorously in this group of patients. W (e) analyzed the effect of RDN on BP in patients with moderate TRH who were retrospectively found to be completely adherent to their antihypertensive medication.Methods: Our study cohort comprised 40 patients with moderate TRH [office BP >= 140/90 but = 130/80 mmHg] who underwent catheter-based RDN. Further major inclusion criterion was complete adherence to their medication (>= 80% intake of their prescribed antihypertensive drugs) at baseline (assessed by retrospective toxicological analysis).Results: Six months after RDN, office BP was reduced by -10/- 6mmHg (SBP: 149 +/- 6 vs. 139 +/- 15 mmHg; DBP: 81 +/- 12 vs. 75 +/- 10 mmHg; both P < 0.001) and 24-h ABPM by -7/-4mmHg (SBP: 150 +/- 14 vs. 143 +/- 16 mmHg, P = 0.005; DBP: 82 +/- 10 vs. 78 +/- 9 mmHg, P = 0.009). Number of prescribed antihypertensive medication [6.0 (5.0-6.0) vs. 5.5 (5.0-6.0), P = 0.013] and adherence rate (95.2 +/- 7.6 vs. 91.7 +/- 13.9%, P = 0.065) was slightly reduced 6 months after RDN, both likely to underestimate the true BP reduction.Conclusion: Thus, our data indicate that even after given full respect to drug adherence as potential confounder of BP response after RDN, both office and 24-h ABPM were substantially reduced in patients with moderate TRH.