Randomized comparison of renal denervation versus intensified pharmacotherapy including spironolactone in true-resistant hypertension: six-month results from the Prague-15 study
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, multicentrická studie, randomizované kontrolované studie, práce podpořená grantem
PubMed
25421981
DOI
10.1161/hypertensionaha.114.04019
PII: HYPERTENSIONAHA.114.04019
Knihovny.cz E-zdroje
- Klíčová slova
- hypertension resistant to conventional therapy, spironolactone, sympathetic denervation,
- MeSH
- ambulantní monitorování krevního tlaku MeSH
- antihypertenziva aplikace a dávkování farmakologie terapeutické užití MeSH
- axotomie metody MeSH
- dospělí MeSH
- hypertenze farmakoterapie patofyziologie chirurgie MeSH
- katetrizační ablace * MeSH
- kombinovaná farmakoterapie MeSH
- kreatinin krev MeSH
- ledviny inervace chirurgie MeSH
- léková rezistence MeSH
- lidé středního věku MeSH
- lidé MeSH
- metabolická clearance MeSH
- pooperační komplikace epidemiologie MeSH
- prospektivní studie MeSH
- senioři MeSH
- spironolakton terapeutické užití MeSH
- srdeční frekvence účinky léků MeSH
- sympatektomie * škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- antihypertenziva MeSH
- kreatinin MeSH
- spironolakton MeSH
This prospective, randomized, open-label multicenter trial evaluated the efficacy of catheter-based renal denervation (Symplicity, Medtronic) versus intensified pharmacological treatment including spironolactone (if tolerated) in patients with true-resistant hypertension. This was confirmed by 24-hour ambulatory blood pressure monitoring after excluding secondary hypertension and confirmation of adherence to therapy by measurement of plasma antihypertensive drug levels before enrollment. One-hundred six patients were randomized to renal denervation (n=52), or intensified pharmacological treatment (n=54) with baseline systolic blood pressure of 159±17 and 155±17 mm Hg and average number of drugs 5.1 and 5.4, respectively. A significant reduction in 24-hour average systolic blood pressure after 6 months (-8.6 [95% cofidence interval: -11.8, -5.3] mm Hg; P<0.001 in renal denervation versus -8.1 [95% cofidence interval: -12.7, -3.4] mm Hg; P=0.001 in pharmacological group) was observed, which was comparable in both groups. Similarly, a significant reduction in systolic office blood pressure (-12.4 [95% cofidence interval: -17.0, -7.8] mm Hg; P<0.001 in renal denervation versus -14.3 [95% cofidence interval: -19.7, -8.9] mm Hg; P<0.001 in pharmacological group) was present. Between-group differences in change were not significant. The average number of antihypertensive drugs used after 6 months was significantly higher in the pharmacological group (+0.3 drugs; P<0.001). A significant increase in serum creatinine and a parallel decrease of creatinine clearance were observed in the pharmacological group; between-group difference were borderline significant. The 6-month results of this study confirmed the safety of renal denervation. In conclusion, renal denervation achieved reduction of blood pressure comparable with intensified pharmacotherapy.
Citace poskytuje Crossref.org
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