Two-year nighttime blood pressure changes after radiofrequency renal denervation: pooled results from the SPYRAL HTN trials.

IF 4.3 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Kazuomi Kario, David E Kandzari, Felix Mahfoud, Michael A Weber, Roland E Schmieder, Konstantinos Tsioufis, Minglei Liu, Michael Böhm, Raymond R Townsend
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Abstract

Elevated nighttime blood pressure (BP) and abnormal circadian dipping patterns are associated with advanced age and coexisting illnesses and are attributed to autonomic dysfunction. Radiofrequency renal denervation (RF RDN) effectively lowers BP throughout 24 h and thus may provide an effective antihypertensive therapeutic option. This analysis assesses the effects of RDN on nocturnal hypertension with different dipper patterns defined by nighttime/daytime BP ratio (i.e. dippers, non-dippers, risers) through 2 years in patients randomized to RDN from the SPYRAL HTN-OFF MED and -ON MED trials. Office and 24-h ambulatory BP, were also evaluated in patients stratified by age, obstructive sleep apnea (OSA), type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Among 388 patients, the baseline nighttime systolic BP (SBP) was 139.3 ± 11.3 mmHg. Patients with a riser pattern had the highest baseline nighttime SBP (152.7 ± 8.0 mmHg). At 2 years, patients experienced a significant reduction from baseline (p < 0.0001) in nighttime (-12.0 ± 17.1 mmHg), morning (-14.8 ± 20.0 mmHg), daytime (-13.8 ± 14.7 mmHg), and 24-h SBP (-13.4 ± 14.2 mmHg). The greatest reduction in SBP was in risers at nighttime (-23.7 ± 14.3 mmHg). RDN was equally effective in lowering nighttime BP in patients ≥65 years old or with OSA, CKD, or T2DM. In this pooled dataset of RF RDN patients, clinically meaningful reductions in BP over a 24-h period were observed through 2 years irrespective of dipping status. RF RDN may reduce the risk of cardiovascular outcomes in patients with uncontrolled hypertension, especially in those with elevated nighttime BP who may be the most challenging to treat.

射频肾去神经后2年夜间血压变化:来自SPYRAL HTN试验的汇总结果。
夜间血压升高和异常的昼夜节律下降模式与老年和共存疾病有关,并归因于自主神经功能障碍。射频肾去神经支配(RF RDN)在24小时内有效降低血压,因此可能提供有效的抗高血压治疗选择。该分析评估了在SPYRAL HTN-OFF MED和on MED试验中随机分配到RDN的患者中,RDN对夜间高血压的影响,这些患者具有不同的下沉模式,由夜间/白天血压比(即下沉、非下沉、上升)定义。对按年龄、阻塞性睡眠呼吸暂停(OSA)、2型糖尿病(T2DM)和慢性肾病(CKD)分层的患者进行办公室血压和24小时动态血压的评估。在388例患者中,基线夜间收缩压(SBP)为139.3±11.3 mmHg。上升型患者夜间基线收缩压最高(152.7±8.0 mmHg)。2年后,患者经历了较基线的显著降低(p
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来源期刊
Hypertension Research
Hypertension Research 医学-外周血管病
CiteScore
7.40
自引率
16.70%
发文量
249
审稿时长
3-8 weeks
期刊介绍: Hypertension Research is the official publication of the Japanese Society of Hypertension. The journal publishes papers reporting original clinical and experimental research that contribute to the advancement of knowledge in the field of hypertension and related cardiovascular diseases. The journal publishes Review Articles, Articles, Correspondence and Comments.
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