fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2019-4-4-78-88fcmedicine-193Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHВлияние ренальной денервации на показатели суточного профиля артериального давления у пациентов с резистентной гипертензиейImpact of renal denervation on 24-hour blood pressure pattern in patients with resistant hypertensionhttps://orcid.org/0000-0001-5011-0070ЧичковаТ. Ю.ChichkovaT. Yu.

Чичкова Татьяна Юрьевна – кандидат медицинских наук, научный сотрудник отдела диагностики сердечно-сосудистых заболеваний

б-р Сосновый, д. 6, г. Кемерово, 650002

Dr. Tatiana Yu. Chichkova, MD, Research Fellow

6, Sosnovy Boulevard, Kemerovo, 650002

chi4cova@ya.ruhttps://orcid.org/0000-0002-8277-5584МамчурС. Е.MamchurS. E.

Мамчур Сергей Евгеньевич – доктор медицинских наук, заведующий отделом диагностики сердечно-сосудистых заболеваний

б-р Сосновый, д. 6, г. Кемерово, 650002

Dr. Sergey E. Mamchur, MD, DSc, Head of the Division for Cardiovascular Diagnostics

6, Sosnovy Boulevard, Kemerovo, 650002

https://orcid.org/0000-0002-0598-1675РомановаМ. П.RomanovaM. P.

Романова Мария Петровна – младший научный сотрудник отдела диагностики сердечно-сосудистых заболеваний

б-р Сосновый, д. 6, г. Кемерово, 650002

Dr. Maria P. Romanova, MD, Junior Researcher

6, Sosnovy Boulevard, Kemerovo, 650002

https://orcid.org/0000-0002-1933-7768ХоменкоЕ. А.KhomenkoE. A.

Хоменко Егор Александрович – кандидат медицинских наук, научный сотрудник отдела диагностики сердечно-сосудистых заболеваний

б-р Сосновый, д. 6, г. Кемерово, 650002

Dr. Egor A. Khomenko, MD, PhD, Research Fellow

6, Sosnovy Boulevard, Kemerovo, 650002

ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian Federation201930122019447888Copyright © Чичкова Т.Ю., Мамчур С.Е., Романова М.П., Хоменко Е.А., 20192019Чичкова Т.Ю., Мамчур С.Е., Романова М.П., Хоменко Е.А.Chichkova T.Y., Mamchur S.E., Romanova M.P., Khomenko E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/193Цель

Цель. Оценить динамику показателей суточного профиля артериального давления (АД) после выполнения ренальной денервации (РД) в сравнении с группой медикаментозной терапии.

Материал и методы

Материал и методы. В проспективное клиническое исследование включено 45 пациентов с наличием критериев резистентной АГ – 21 мужчина и 24 женщины, средний возраст 53 (43;66) лет. 25 пациентам была проведена РД с применением технологии Vessix renal denervation system, 20 пациентов составили группу консервативной терапии. Исходно и через 12 месяцев после РД проводилось суточное мониторирование АД (СМАД) с оценкой параметров суточного профиля АД.

Результаты

Результаты. Через 12 месяцев группа РД характеризовалась выраженной положительной динамикой в виде достоверного снижения показателей офисного систолического артериального давления (САД) и диастолического артериального давления (ДАД) на 33 и 15 мм рт. ст. и среднего САД и ДАД по данным СМАД на 29 и 12 мм рт. ст., соответственно (р≤0,05). В группе РД также выявлено снижение вариабельности САД днем на 6 (5;12) мм рт. ст. и ночью на 7 (7;10) мм рт. ст. (р≤0,05), без влияния на вариабельность ДАД. Не было выявлено динамики утреннего подъема АД в исследуемых группах, хотя утреннее САД после выполнения денервации имело тенденцию к снижению со 174 (130;180) мм рт. ст. до 156 (130;165) мм рт. ст., (р= 0,06). К 12 месяцам наблюдения количество пациентов с нормальным типом снижения АД («dipper») в ночное время увеличилось с 16 до 44% (р=0,015). В группе консервативной терапии достоверной динамики суточного профиля АД не выявлено.

Заключение

Заключение. Отдаленная эффективность РД превосходит консервативную тактику в отношении снижения офисных и средних значений АД, а также оказывает положительное влияние на показатели суточного профиля АД.

Aim

Aim. To estimate the dynamics of 24-hour blood pressure pattern in patients with resistant hypertension after renal denervation in comparison with the conservative treatment group.

Methods

Methods. We enrolled 45 patients (21 men and 24 women, mean age 53 (43-66) years) with resistant hypertension. Renal denervation was performed in 25 patients using Vessix renal denervation system while the conservative treatment group included 20 patients. Monitoring of 24-hour blood pressure pattern was performed before renal denervation and after 1 year of follow-up.

Results

Results. Twelve months after renal denervation, patients with resistant hypertension had a significant reduction in office blood pressure (33 and 15 mmHg for systolic and diastolic blood pressure, respectively) and 24-hour average blood pressure (29 and 12 mmHg, for systolic and diastolic blood pressure, respectively). Another beneficial effect of renal denervation was a decrease in systolic blood pressure variability both throughout the day and at night (6 (5-12) and 7 (7-10) mmHg, respectively); however, no changes in diastolic blood pressure variability have been registered. Despite renal denervation did not affect the morning blood pressure surge, morning systolic blood pressure reduced from 174 (130180) mmHg to 156 (130-165) mmHg. After 1 year of follow-up, the proportion of dippers increased from 16 to 44%. In contrast to the patients who underwent renal denervation, there were no significant changes in 24-hour blood pressure pattern in the conservative treatment group.

Conclusion

Conclusion. After 1 year of follow-up, renal denervation can be considered as an option superior to conservative treatment in patients with resistant hypertension, as it significantly improved 24-hour blood pressure pattern.

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The authors declare that there are no conflicts of interest present.