抗性高血圧患者における異なる腎臓消毒装置と技術に関する3つのグループによるランダム化試験 (RADIOSOUND-HTN)
Karl Fengler1, Karl-Philipp Rommel1, Stephan Blazek1
1Department of Cardiology, Heart Center Leipzig at University of Leipzig, Germany (K.F., K.-P.R., S.B., C.B., P.H., M.v.R., S.W., S.D., H.T., P.L.).
Circulation
|December 28, 2018
まとめ
超音波による腎交感性消化 (RDN) は,耐性高血圧患者の主な腎動脈のみを標的とした放射性RDNよりも血圧を有意に低下させた. 組み合わせた放射性RDNは優れた結果を示さなかった.
科学分野:
- 心血管医学
- 介入心臓科
- 高血圧管理
背景:
- 耐性高血圧は重大な臨床的課題となっている.
- 放射線周波数 (RF) と超音波技術を用いた内血管性腎交感性消化 (RDN) が有効であることが示されています.
- RFと超音波RDNの間の直接的な比較は限られている.
研究 の 目的:
- 耐性高血圧患者の内血管超音波ベースのRDNとRFベースのRDNの有効性を比較する.
- 異なるRF RDN戦略を評価するには,主動脈のみと主動脈と枝を比較します.
- 3ヶ月後の静脈性昼間循環血圧の変化の主なエンドポイントを決定する.
主な方法:
- 120人の耐性高血圧患者の3つのRDN戦略を比較したランダム化対照試験.
- グループ1: 主要腎動脈のRF RDN
- グループ2: 主動脈,横の枝,および付属体のRF RDN.
- グループ3: 腎動脈の主体の超音波によるRDN
主要な成果:
- 全てのRDN治療法では,昼間循環血圧を3ヶ月減らせました.
- 主腎動脈のみのRF RDNと比較して,Ultrasound RDNは著しく高い血圧低下を示した (−13. 2対−6. 5mmHg).
- 2つのRF RDN戦略と,超音波RDNと組み合わせたRF RDNアプローチの間で,血圧低下の有意な違いは観察されなかった.
結論:
- 血管内超音波によるRDNは,抵抗性高血圧の主要な腎動脈のみを標的とするRFRNよりも優れています.
- 横の枝やアクセサリーを含む包括的なRF RDNアプローチは,主動脈のみをターゲットにするよりも優れた結果をもたらさなかった.
- 超音波RDNは高血圧の管理に有望な代替手段です.
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