Retinal microperfusion after renal denervation in treatment-resistant hypertensive patients
Retinal microperfusion after renal denervation in treatment-resistant hypertensive patients
复制标题
难治性高血压患者肾去神经术后视网膜微灌注
DOI：
10.1007/s00392-015-0845-0
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发表时间：
2015
影响因子：
5
通讯作者：
Schmieder RE
中科院分区：
文献类型：
--
作者：
Harazny JM;Schmid A;Ditting T;Veelken R;Bladowski M;Michelson G;Uder M;Schmieder RE
背景：高脉压和高动脉血流会导致微血管损伤，从而增加心脑血管并发症。随着高血压疾病的晚期，已显示出夸张的脉冲性视网膜毛细血管流动（RCF），但缺乏有关介入效果的数据。方法51例真正难治性高血压（TRH）患者采用simplicity Flex™导尿管行肾去神经支配（RDN）治疗，随访12个月。在RDN前、6个月（6个月）和12个月（12个月）使用扫描激光多普勒血流法（SLDF）无创评估RCF。测量收缩期和舒张期RCF，计算脉冲RCF（收缩期-舒张期RCF之差）。此外，还评估了闪烁光诱导的血管舒张（代表血管舒张能力）。结果与基线值相比，RDN后6 M和12 M收缩压和舒张压办公室压（BP）以及24小时ABPM显著降低（均p< 0.001）。RDN后脉冲RCF显著降低6 M（231±81 AU对208±68 AU，p= 0.046）和12 M(194±72 AU,p= 0.001)，而平均RCF不变。此外，RDN后闪烁光诱导的血管舒张明显增加（p= 0.043）。结论高血压合并TRH患者在RDN后6 M和12 M脉冲RCF降低，血管舒张能力增加，同时血压和心率降低。RDN后脉冲RCF的减少意味着脉冲血流对血管壁的剪切应力的减少。这和血管扩张能力的增加表明视网膜（和潜在的大脑）微循环的改善。
BackgroundHigh pulsatile pressure and flow in the arteries causes microvascular damage, and hence increased cardio-, and cerebrovascular complications. With advanced stages of hypertensive disease, an exaggerated pulsatile retinal capillary flow (RCF) has been shown, but data about interventional effect are missing.MethodsFifty-one patients with true treatment-resistant hypertension (TRH) underwent renal denervation (RDN) using the Symplicity Flex™ catheter and were followed for 12 months. RCF was assessed non-invasively using Scanning laser Doppler flowmetry (SLDF) before, 6 (6 M), and 12 (12 M) months after RDN. RCF was measured in systole and diastole and pulsed RCF (difference of RCF in systole minus diastole) was calculated. In addition, flicker light-induced vasodilation (representing vasodilatory capacity) was assessed.ResultsSystolic and diastolic office blood pressure (BP) as well as 24-h ABPM decreased significantly 6 M and 12 M after RDN, compared to baseline values (allp< 0.001). There was a significant reduction of pulsed RCF 6 M (231 ± 81 versus 208 ± 68 AU,p= 0.046) and 12 M (194 ± 72 AU,p= 0.001) after RDN, whereas the mean RCF was unchanged. Moreover, there was a significant increase of flicker light-induced vasodilation after RDN (p= 0.043).ConclusionIn hypertensive patients with TRH, we observed a decrease of pulsed RCF 6 M and 12 M after RDN and an increase of vasodilatory capacity, in parallel to decreases in BP and heart rate. The reduction of pulsed RCF after RDN implies a decrease of shear stress on the vascular wall by the pulsed blood flow. This and the increment of vasodilatory capacity suggest an improvement of retinal (and potentially cerebral) microcirculation.
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影响因子：
4.9
作者：
Harazny, Joanna M.;Raff, Ulrike;Schmieder, Roland E.
通讯作者：
Schmieder, Roland E.
影响因子：
2
作者：
G. Michelson;B. Schmauss;M. Langhans;J. Harazny;M. Groh
通讯作者：
G. Michelson;B. Schmauss;M. Langhans;J. Harazny;M. Groh
血管紧张素 II 1 型受体阻断对视网膜内皮功能的影响
影响因子：
4.9
作者：
C. Ott;M. Schlaich;J. Harazny;B. Schmidt;G. Michelson;R. Schmieder
通讯作者：
R. Schmieder
去肾神经术后维生素 D 状态与血压反应的关系
影响因子：
5
作者：
J. Pöss;F. Mahfoud;C. Ukena;M. Esler;M. Schlaich;D. Hering;B. Cremers;U. Laufs;M. Böhm
通讯作者：
M. Böhm
扫描激光多普勒血流计无创评估皮下小动脉中管腔比与视网膜小动脉壁管腔比的关系
影响因子：
4.9
作者：
D. Rizzoni;E. Porteri;S. Duse;C. de Ciuceis;C. A. Rosei;E. La Boria;F. Semeraro;C. Costagliola;A. Sebastiani;P. Danzi;G. Tiberio;S. Giulini;F. Docchio;G. Sansoni;A. Sarkar;E. Rosei
通讯作者：
E. Rosei