Renal nerve stimulation: complete versus incomplete renal sympathetic denervation.

IF 1.8 4区医学 Blood Pressure Pub Date : 2021-12-01 Epub Date: 2021-10-14 DOI:10.1080/08037051.2021.1982376

Annemiek F Hoogerwaard, Ahmet Adiyaman, Mark R de Jong, Jaap-Jan J Smit, Jan-Evert Heeg, Boudewijn A A M van Hasselt, Arif Elvan

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引用次数: 5

Abstract

Purpose: Blood pressure (BP) reduction after renal sympathetic denervation (RDN) is highly variable. Renal nerve stimulation (RNS) can localize sympathetic nerves. The RNS trial aimed to investigate the medium-term BP-lowering effects of the use of RNS during RDN, and explore if RNS can check the completeness of the denervation.

Material and methods: Forty-four treatment-resistant hypertensive patients were included in the prospective, single-center RNS trial. The primary study endpoint was change in 24-h BP at 6- to 12-month follow-up after RDN. The secondary study endpoints were the acute procedural RNS-induced BP response before and after RDN; number of antihypertensive drugs at follow-up; and the correlation between the RNS-induced BP increase before versus after RDN (delta [Δ] RNS-induced BP).

Results: Before RDN, the RNS-induced systolic BP rise was 43(±21) mmHg, and decreased to 9(±12) mmHg after RDN (p < 0.001). Mean 24-h systolic/diastolic BP decreased from 147(±12)/82(±11) mmHg at baseline to 135(±11)/76(±10) mmHg (p < 0.001/<0.001) at follow-up (10 [6-12] months), with 1 antihypertensive drug less compared to baseline. The Δ RNS-induced BP and the 24-h BP decrease at follow-up were correlated for systolic (R = 0.44, p = 0.004) and diastolic (R = 0.48, p = 0.003) BP. Patients with ≤0 mmHg residual RNS-induced BP response after RDN had a significant lower mean 24-h systolic BP at follow-up compared to the patients with >0 mmHg residual RNS-induced BP response (126 ± 4 mmHg versus 135 ± 10 mmHg, p = 0.04). 83% of the patients with ≤0 mmHg residual RNS-induced BP response had normal 24-h BP at follow-up, compared to 33% in the patients with >0 mmHg residual RNS-induced BP response (p = 0.023).

Conclusion: The use of RNS during RDN leads to clinically significant and sustained lowering of 24-h BP with fewer antihypertensive drugs at follow-up. RNS-induced BP changes were correlated with 24-h BP changes at follow-up. Moreover, patients with complete denervation had significant lower BP compared to the patients with incomplete denervation.

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肾神经刺激:完全与不完全的肾交感神经去支配。

目的:肾交感神经去支配(RDN)后血压(BP)的降低是高度可变的。肾神经刺激(RNS)可以定位交感神经。RNS试验旨在探讨RDN期间使用RNS的中期降压效果，并探讨RNS是否可以检查去神经的完整性。材料和方法:44例难治性高血压患者纳入前瞻性单中心RNS试验。主要研究终点是RDN后6至12个月随访时24小时血压的变化。次要研究终点为RDN前后急性程序性rns诱导的血压反应;随访时抗高血压药物数量;以及RDN前后rns诱导的血压升高的相关性(delta [Δ] rns诱导的血压)。结果:RDN前rns诱导的收缩压升高43(±21)mmHg, RDN后rns诱导的收缩压升高9(±12)mmHg (p = 0.44, p = 0.004)，舒张压升高(R = 0.48, p = 0.003)。RDN后残余rns诱导血压反应≤0 mmHg的患者随访时平均24小时收缩压明显低于残余rns诱导血压反应>0 mmHg的患者(126±4 mmHg vs 135±10 mmHg, p = 0.04)。≤0 mmHg残留rns诱导血压反应的患者随访时24小时血压正常的占83%，而>0 mmHg残留rns诱导血压反应的患者随访时24小时血压正常的占33% (p = 0.023)。结论:RDN期间使用RNS可显著且持续降低24小时血压，且随访时降压药较少。rns诱导的血压变化与随访时24小时血压变化相关。此外，完全去神经支配患者的血压明显低于不完全去神经支配患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Pressure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

3.20

自引率

5.60%

发文量

期刊介绍： For outstanding coverage of the latest advances in hypertension research, turn to Blood Pressure, a primary source for authoritative and timely information on all aspects of hypertension research and management. Features include: • Physiology and pathophysiology of blood pressure regulation • Primary and secondary hypertension • Cerebrovascular and cardiovascular complications of hypertension • Detection, treatment and follow-up of hypertension • Non pharmacological and pharmacological management • Large outcome trials in hypertension.