Περίληψη:
BACKGROUND The renin-angiotensin-aldosterone system plays a key role in
blood pressure (BP) regulation and is the target of several
antihypertensive medications. Renal denervation (RDN) is thought to
interrupt the sympathetic mediated neurohormonal pathway as part of its
mechanism of action to reduce BP. OBJECTIVES The purpose of this study
was to evaluate plasma renin activity (PRA) and aldosterone before and
after RDN and to assess whether these baseline neuroendocrine markers
predict response to RDN. METHODS Analyses were conducted in patients
with confirmed absence of antihypertensive medication. Aldosterone and
PRA levels were compared at baseline and 3 months post-procedure for RDN
and sham control groups. Patients in the SPYRAL HTN-OFF MED Pivotal
trial were separated into 2 groups, those with baseline PRA >= 0.65
ng/ml/h (n = 110) versus < 0.65 ng/ml/h (n = 116). Follow-up treatment
differences between RDN and sham control groups were adjusted for
baseline values using multivariable linear regression models. RESULTS
Baseline PRA was similar between RDN and control groups (1.0 +/- 1.1
ng/ml/h vs. 1.1 +/- 1.1 ng/ml/h; p = 0.37). Change in PRA at 3 months
from baseline was significantly greater for RDN compared with control
subjects (-0.2 +/- 1.0 ng/ ml/h; p = 0.019 vs. 0.1 +/- 0.9 ng/ml/h; p =
0.14), p = 0.001 for RDN versus control subjects, and similar
differences were seen for aldosterone: RDN compared with control
subjects (-1.2 +/- 6.4 ng/dl; p = 0.04 vs. 0.4 +/- 5.4 ng/dl; p = 0.40),
p = 0.011. Treatment differences at 3 months in 24-h and office systolic
blood pressure (SBP) for RDN versus control patients were significantly
greater for patients with baseline PRA >= 0.65 ng/ml/h versus < 0.65
ng/ml/h, despite similar baseline BP. Differences in office SBP changes
according to baseline PRA were also observed earlier at 2 weeks
post-RDN. CONCLUSIONS Plasma renin activity and aldosterone levels for
RDN patients were significantly reduced at 3 months when compared with
baseline as well as when compared with sham control. Higher baseline PRA
levels were associated with a significantly greater reduction in office
and 24-h SBP. (SPYRAL PIVOTAL SPYRAL HTN-OFF MED Study; NCT02439749) (J
Am Coll Cardiol 2021;77:2909-19) (c) 2021 The Authors. Published by
Elsevier on behalf of the American College of Cardiology Foundation.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Συγγραφείς:
Mahfoud, Felix
Townsend, Raymond R.
Kandzari, David E. and
Kario, Kazuomi
Schmieder, Roland E.
Tsiou, Konstantinos and
Pocock, Stuart
David, Shukri
Patel, Kiritkumar
Rao, Anjani
and Walton, Antony
Bloom, Jason E.
Weber, Thomas
Suppan,
Markus
Lauder, Lucas
Cohen, Sidney A.
McKenna, Pamela and
Fahy, Martin
Boehm, Michael
Weber, Michael A.
