肾脏去神经术可使中度高血压患者受益

巴黎——欧洲经皮心血管介入学会(EAPCI)2013年会上公布的一项初步研究表明，肾脏去神经术(RDN)或有助于降低耐药性中度高血压患者的血压。

德国埃尔兰根大学医院的Roland E. Schmieder医生报告称，这项纳入54例患者的单中心非对照研究表明，对于这些平均基线血压为151/82 mmHg的耐药性高血压患者而言，RDN是一种安全且相当有效的治疗方法。

这些患者虽然一直服用包括1种利尿剂在内的至少3种降压药，但诊室血压测量值仍保持在140/90~160/100 mmHg。入组标准还包括24 h血压监测显示平均血压≥130/80 mmHg。受试者平均年龄为64岁，均接受了Symplicity Flex系统标准RDN治疗。


Roland E. Schmieder医生

结果显示，共计51%的受试者治疗后6个月血压降至140/90 mmHg以下。该比例高于此前报道的Symplicity HTN-2试验结果，后者显示39%的重度耐药性高血压患者经RDN治疗后6个月血压达标(Lancet 2010;376:1903-9)。

本项研究受试者的血压下降程度显著小于Symplicity HTN-2试验受试者，术后6个月血压下降值分别为12.5/7.5 mmHg和32/12 mmHg。但研究者认为，由于本项研究受试者接受治疗时的血压远远低于Symplicity HTN-2试验受试者，因此前者血压降低幅度较小在意料之中。“基线血压越低，对RDN的应答就越小”，有关RDN的多年研究结果已明确了这一关系。

受试者未发生手术并发症。除诊室血压测量值下降外，受试者术后6个月心率平均下降4 bpm。虽然医生建议继续按常规剂量服药，但37%的患者减少了降压药剂量。此外，无1例患者在随访期间增加降压药。

研究者总结指出，采用RDN治疗中度耐药性高血压的结果令人鼓舞。研究者计划在近期开展一项多中心对照研究，以便更确切评估收缩压为140~159 mmHg的耐药性高血压患者接受RDN治疗的安全性和有效性。

该研究没有接受商业资助。Schmieder医生报告称担任Symplicity肾脏去神经系统生产商美敦力公司的顾问并获得了该公司的研究经费支持。

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By: MITCHEL L. ZOLER, Cardiology News Digital Network

PARIS – Renal denervation may help lower blood pressure in patients with moderate hypertension that is resistant to drug treatment, a study has shown.

In a pilot, uncontrolled study with 54 patients at one German center, renal denervation was safe and reasonably effective for patients with treatment-resistant hypertension and an average baseline blood pressure of151/82 mm Hg.

The patients in the study had persistent office blood pressure measures of at least 140/90 mm Hg but less than 160/100 mm Hg, despite stable treatment with at least three antihypertensive drugs, including one diuretic. To enter the study, patients also needed 24-hour blood pressure monitoring showing consistent blood pressure levels of at least 130/80 mm Hg.

A total of 51% of the patients reached their target blood pressure of less than 140/90 mm Hg at 6 months after renal denervation treatment, Dr. Roland E. Schmieder said at the annual meeting of the European Association of Percutaneous Cardiovascular Intervention.

The percentage of patients reaching their goal pressure in the new study surpassed the outcome reported in the trial, which showed that 39% of patients with severe treatment-resistant hypertension reached their goal pressure 6 months after renal denervation (Lancet 2010;376:1903-9).

Patients in the new study had their blood pressure fall by substantially less than in the study, by an average of 12.5/7.5 mm Hg after 6 months in the new study, compared with 32/12 mm Hg in the renal denervation arm of Symplicity HTN-2. However, the smaller reduction was expected because patients in the new study entered treatment with much lower blood pressures than did patients in the older trial.

"The lower the starting blood pressure, the less the response" to renal denervation, explained Dr. Schmieder, professor and head of the clinical research center of hypertension and vascular medicine at University Hospital in Erlangen, Germany. Several years of study on the effect of renal denervation clearly established this relationship, he noted.

The new study enrolled patients with a mean age of 64 years who all underwent standard renal denervation treatment using the Symplicity Flex system. The procedures produced no complications, and in addition to reducing office blood pressure measurements, the treatment produced an average reduction in heart rate of 4 bpm after 6 months. The reported changes in blood pressure occurred even though 37% of the patients in the study reduced their antihypertensive treatment regimen, despite instructions from their physicians to continue their usual treatment dosages. Moreover, none of the patients received an increase in their hypertension treatment medications during follow-up, Dr. Schmieder said.

"Our data are encouraging" for using renal denervation to treat moderate treatment-resistant hypertension, he concluded. Researchers will soon start a multicenter, controlled study to more definitively assess the safety and efficacy of renal denervation in patients with resistant hypertension with systolic blood pressures of 140-159 mm Hg, Dr. Schmieder said.

The study received no commercial support. Dr. Schmieder said he has been a consultant to and has received research support from Medtronic, the company that markets the Symplicity renal denervation systems.