经皮经导管射频消融去肾交感神经术治疗中青年难治性高血压：6个月临床结果

Renal denervation for resistant hypertension in patients less than 65-year-old:6-month clinical outcomes

目的评估经皮经导管射频消融去肾交感神经术(RDN)治疗中青年难治性高血压的安全性和中期疗效。方法采用前瞻性队列研究,于2012年11月至2014年11月在阜外医院连续入选接受RDN治疗的中青年难治性高血压患者。观察RDN治疗的安全性及中期疗效:主要有效性指标为术后6个月诊室血压和24h平均血压较基线的变化,主要安全性指标为术后6个月时主要不良事件的发生率。结果共入组50例患者,年龄26~62(41.9±10.6)岁,女性18例(36.0%)。术后6个月时,诊室血压和24h平均血压分别较基线下降了(23.7±14.5)/(11.5±7.9)和(11.1±8.5)/(7.1±6.2)mm Hg,服用降压药物的种类从术前的4.0(4.0~4.0)种降至术后6个月时的4.0(3.0~4.0)种(均P<0.001)。术后6个月肾功能与术前比较差异无统计学意义(P>0.05)。1例患者围手术期发生股动脉假性动脉瘤,其余患者围手术期和6个月随访期间未发生不良事件。结论 RDN治疗中青年难治性高血压安全,中期降压疗效肯定。

Objective To investigate the safety and mid-term efficacy of renal denervation（RDN）in less than 65-year-old Chinese patients with resistant hypertension. Methods In the prospective cohort study,the patients with resistant hypertension were continuously enrolled to undergo RDN between November 2012 and November 2014 using LEPU single-electrode ablation catheter. The primary effectiveness endpoints were reductions in office blood pressure and 24-hour ambulatory blood pressure（24 h-ABP）at six months. The primary safety endpoint was the incidence of major adverse event through 6 months. Results A total of 50 consecutive patients,aged between 26 and 62 years old（41.9±10.6）,were enrolled,in which 18（36.0%）were female. At six months after RDN,the office blood pressure and 24-h ABP were separately reduced by（23.7±14.5）/（11.5±7.9）mm Hg and（11.1±8.5）/（7.1±6.2）mm Hg,with the reduction of the number of antihypertensive agents from 4.0（4.0-4.0）at baseline to 4.0（3.0-4.0）（all P〉0.001）. There was no significant change of renal function（P〉0.05）and no major adverse events occurred. Only one patient suffered from femoral artery pseudoaneurysm with no sequelae.Conclusion RDN is safe and effective in lowering blood pressure in the less than 65-year-old Chinese cohort with resistant hypertension.