基线血压对肾动脉去交感神经术降压效果的影响

Hypertensive effect of renal denervation in patients with resistant hypertension:role of baseline blood pressure

目的:分析顽固性高血压患者基线因素对肾动脉去交感神经术(RDN)降压疗效的影响,为RDN临床病患的入选提供初步指导。方法:回顾性分析2013-2015年于普陀医院心内科行RDN治疗的23例顽固性高血压患者记录数据,采用单因素筛选和多因素分析得出RDN降压效果的主要影响因素。结果:术前24h平均收缩压水平是影响RDN降压效果的最重要因素。无论低压组(ABPSYS≤150mmHg)还是高压组(ABPSYS>150mmHg)经过RDN术后半年的24h平均收缩压血压都维持在140mmHg左右。低压组患者,术后6个月平均血压减少(8.3±5.7)/(4.6±3.2)mmHg(P>0.05),RDN有效率(术后6个月收缩压值下降大于或等于10mmHg)为62.5%;高压组降压(28.9±12.1)/(12.4±7.4)mmHg(与术前比较P<0.05),RDN有效率高达93.3%。结论:基线血压显著影响RDN降压效果,且ABPSYS>150mmHg患者RDN术降压效果更明显。根据动态血压基线值选择合适的患者,RDN术可以使患者更能获益。

Objective：To investigate whether baseline 24 hambulatory BP（ABP）affects BP reduction following RDN in resistant hypertensive patients.Method：Twenty patients with resistant hypertension admitted and treated with RDN in Department of Cardiology,Putuo Hospital,from 2013 to 2015 were selected for this study.According to different BP levels,they were divided into the high BP group（ABPSYS 〉150 mmHg）and the low BP group（ABPSYS ≤150mmHg）,and baseline 24 h ambulatory BP monitoring were useful for the evaluation of BP reduction following RDN.Result：At 6 months after RDN,the ABP reduction in the low BP group was（8.3±5.7）/（4.6± 3.2）mmHg with a responder rate of 62.5%.Whereas,in the high BP group,the BP reduction was（21.7±12.1）/（10.5±7.4）mmHg with a responder rate of 93.3%.Conclusion：The baseline blood pressure significantly affects the hypertensive action of RDN in patients with resistant hypertension.The patients with mean baseline systolic ABP of〉150 mmHg are preferred to select for RDN surgery.