背景:准确选择可能对肾脏去神经(RDN)有反应的患者对于优化高血压患者的治疗结果至关重要。本系统评价旨在评估预测RDN反应的患者特异性因素。
结果:我们关注的是接受RDN的高血压患者。根据患者的基线特征对患者进行分类。主要结果是RDN后血压(BP)降低。纳入了随机对照试验和非随机研究。我们使用相应的工具评估了偏差的风险,并进一步采用了建议评估的分级,发展,和评估方法,以评估证据的总体质量。共有50项研究最终纳入本系统综述,其中17项研究用于荟萃分析.较高的基线心率和较低的脉搏波速度显示与RDN在24小时收缩压降低时的显着降压疗效相关(加权平均差异,-4.05[95%CI,-7.33至-0.77];加权平均差,-7.20[95%CI,-9.79至-4.62],分别)。此外,基于定性分析,较高的基线BP,直立性高血压,压力反射敏感性受损,据报道,一些生物标志物也与RDN后血压显著降低相关。
结论:在使用RDN治疗的高血压患者中,更高的心率,较低的脉搏波传导速度与RDN后血压显著降低有关。其他因素,包括较高的基线血压,高血压患者体位性高血压,BP变异性,心脏压力反射敏感性受损,据报道,一些生物标志物也与更好的血压对RDN的反应相关。
BACKGROUND: The accurate selection of patients likely to respond to renal denervation (RDN) is crucial for optimizing treatment outcomes in patients with hypertension. This systematic review was designed to evaluate patient-specific factors predicting the RDN response.
RESULTS: We focused on individuals with hypertension who underwent RDN. Patients were categorized based on their baseline characteristics. The primary outcome was blood pressure (BP) reduction after RDN. Both randomized controlled trials and nonrandomized studies were included. We assessed the risk of bias using corresponding tools and further employed the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the overall quality of evidence. A total of 50 studies were ultimately included in this systematic review, among which 17 studies were for meta-analysis. Higher baseline heart rate and lower pulse wave velocity were shown to be associated with significant antihypertensive efficacy of RDN on 24-hour systolic BP reduction (weighted mean difference, -4.05 [95% CI, -7.33 to -0.77]; weighted mean difference, -7.20 [95% CI, -9.79 to -4.62], respectively). In addition, based on qualitative analysis, higher baseline BP, orthostatic hypertension, impaired
baroreflex sensitivity, and several biomarkers are also reported to be associated with significant BP reduction after RDN.
CONCLUSIONS: In patients with hypertension treated with the RDN, higher heart rate, and lower pulse wave velocity were associated with significant BP reduction after RDN. Other factors, including higher baseline BP, hypertensive patients with orthostatic hypertension, BP variability, impaired cardiac
baroreflex sensitivity, and some biomarkers are also reported to be associated with a better BP response to RDN.