Beta-Blocker Use Is Associated with Higher Renal Tissue Oxygenation in Hypertensive Patients Suspected of Renal Artery Stenosis
Beta-Blocker Use Is Associated with Higher Renal Tissue Oxygenation in Hypertensive Patients Suspected of Renal Artery Stenosis
复制标题
DOI：
10.1159/000445302
复制
发表时间：
2016-01-01
影响因子：
3.8
通讯作者：
Hundley, William G.
中科院分区：
文献类型：
--
作者：
Hall, Michael E.;Rocco, Michael V.;Hundley, William G.
背景：慢性肾脏缺氧影响慢性肾脏病（CKD）的进展。血氧水平依赖性 (BOLD) 磁共振 (MR) 是一种用于评估肾氧合的无创工具。 β-受体阻滞剂对肾脏血流动力学和氧合的影响尚不完全清楚。我们试图确定怀疑肾动脉狭窄的患者中β受体阻滞剂的使用、肾皮质和髓质氧合以及肾血流量之间的关系。方法：我们使用 BOLD MR 测量肾皮质和髓质氧合，并使用 MR 相差技术测量 38 名疑似肾动脉狭窄的参与者的肾动脉血流量。结果：长期β受体阻滞剂治疗与肾皮质（p < 0.001）和髓质（p = 0.03）氧合改善相关，而钙通道阻滞剂或利尿剂的使用与皮质或髓质氧合无关。接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂与髓质氧合减少相关（p = 0.01）。在多变量模型中，长期接受β受体阻滞剂是肾组织氧合的唯一显着预测因子（(3 = 8.4，p = 0.008）。β受体阻滞剂治疗与肾动脉血流量的显着变化无关，这表明肾氧合改善可能与肾耗氧量减少有关。结论：除了已知的降低肾病患者心血管死亡率的益处外，β受体阻滞剂还可以减少或预防高血压、糖尿病和糖尿病患者的肾功能障碍进展。肾血管疾病，部分通过减少肾脏耗氧量来治疗。这些观察结果可能对 CKD 患者的治疗具有重要意义 (C) 2016 S. Karger AG，巴塞尔。
Background: Chronic renal hypoxia influences the progression of chronic kidney disease (CKD). Blood oxygen level-dependent (BOLD) magnetic resonance (MR) is a noninvasive tool for the assessment of renal oxygenation. The impact of beta-blockers on renal hemodynamics and oxygenation is not completely understood. We sought to determine the association between beta-blocker use, renal cortical and medullary oxygenation, and renal blood flow in patients suspected of renal artery stenosis. Methods: We measured renal cortical and medullary oxygenation using BOLD MR and renal artery blood flow using MR phase contrast techniques in 38 participants suspected of renal artery stenosis. Results: Chronic beta-blocker therapy was associated with improved renal cortical (p < 0.001) and medullary (p = 0.03) oxygenation, while the use of calcium channel blockers or diuretics showed no association with either cortical or medullary oxygenation. Receipt of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with reduced medullary oxygenation (p = 0.01). In a multivariable model, chronic receipt of beta-blockers was the only significant predictor of renal tissue oxygenation ((3 = 8.4, p = 0.008). Beta-blocker therapy was not associated with significant changes in renal artery blood flow, suggesting that improved renal oxygenation may be related to reduced renal oxygen consumption. Conclusions: In addition to known benefits to reduce cardiovascular mortality in patients with renal disease, beta-blockers may reduce or prevent the progression of renal dysfunction in patients with hypertension, diabetes, and renovascular disease, partly by reducing renal oxygen consumption. These observations may have important implications for the treatment of patients with CKD. (C) 2016 S. Karger AG, Basel