Adherence to Antihypertensive Treatment and the Blood Pressure-Lowering Effects of Renal Denervation in the Renal Denervation for Hypertension (DENERHTN) Trial

被引：128

作者：

Azizi, Michel ^{[1
,2
,3
]}

Pereira, Helena ^{[3
,4
]}

Hamdidouche, Idir ^{[5
]}

Gosse, Philippe ^{[6
]}

Monge, Matthieu ^{[7
]}

Bobrie, Guillaume ^{[2
]}

Delsart, Pascal ^{[8
]}

Mounier-Vehier, Claire ^{[8
]}

Courand, Pierre-Yves ^{[9
,10
,11
,12
,13
,14
]}

Lantelme, Pierre ^{[9
,10
,11
,12
,13
,14
]}

Denolle, Thierry ^{[15
]}

Dourmap-Collas, Caroline ^{[16
]}

Girerd, Xavier ^{[17
]}

Halimi, Jean Michel ^{[18
]}

Zannad, Faiez ^{[19
]}

Ormezzano, Olivier ^{[20
]}

Vaisse, Bernard ^{[21
]}

Herpin, Daniel ^{[22
]}

Ribstein, Jean ^{[23
]}

Chamontin, Bernard ^{[24
]}

Mourad, Jean-Jacques ^{[25
]}

Ferrari, Emile ^{[26
]}

Plouin, Pierre-Francois ^{[1
,2
]}

Jullien, Vincent ^{[1
,5
,27
]}

Sapoval, Marc ^{[1
,28
]}

Chatellier, Gilles ^{[1
,3
,4
]}

机构：

[1] Paris Descartes Univ, Paris, France

[2] Hop Europeen Georges Pompidou, AP HP, Hypertens Unit, F-75015 Paris, France

[3] INSERM, CIC1418, Paris, France

[4] Hop Europeen Georges Pompidou, AP HP, Clin Res Unit, F-75015 Paris, France

[5] Hop Europeen Georges Pompidou, AP HP, Dept Pharmacol, F-75015 Paris, France

[6] Hop St Andre, Ctr Hosp Univ Bordeaux, Cardiol Hypertens Dept, Bordeaux, France

[7] Inst Mutualiste Montsouris, Paris, France

[8] Hop Cardiol, Ctr Hosp Reg Univ Lille, Med Vasc & HTA, Lille, France

[9] Hosp Civils Lyon, European Soc Hypertens Excellence Ctr, Dept Cardiol, Hop Croix Rousse, Lyon, France

[10] Univ Lyon, CREATIS, UMR5220, Lyon, France

[11] INSERM, U1044, Lyon, France

[12] INSA Lyon, Lyon, France

[13] Univ Lyon 1, Lyon, France

[14] Hosp Civils Lyon, Lyon, France

[15] Hop Arthur Gardiner, Ctr Excellence HTA Rennes Dinard, Rennes, France

[16] Ctr Hosp Univ Rennes, Serv Cardiol & Malad Vasc, Rennes, France

[17] Hop La Pitie Salpetriere, AP HP, Paris, France

[18] Hop Bretonneau, Tours, France

[19] CHU Nancy Brabois, Nancy, France

[20] CHU Grenoble, Grenoble, France

[21] CHU Timone, Marseille, France

[22] CHU Poitiers, Cardiol, Poitiers, France

[23] CHRU Montpellier, Montpellier, France

[24] CHU Rangueil, Toulouse, France

[25] Hop Avicenne, Bobigny, France

[26] Hop Louis Pasteur, Nice, France

[27] INSERM, UMR 1129, Paris, France

[28] Hop Europeen Georges Pompidou, AP HP, Vasc & Oncol Intervent Radiol Dept, F-75015 Paris, France

来源：

CIRCULATION | 2016年 / 134卷 / 12期

关键词：

ablation techniques; hypertension; kidney; medications; nervous system; sympathetic nervous system; TREATMENT-RESISTANT HYPERTENSION; SYMPATHETIC DENERVATION; SCALE;

D O I：

10.1161/CIRCULATIONAHA.116.022922

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

BACKGROUND: The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure-lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control. METHODS: One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was >= 135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients. RESULTS: The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively (P=0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was -6.7 mm Hg (P=0.0461) in fully adherent and -7.8 mm Hg (P=0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients. CONCLUSIONS: In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (approximate to 50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone.

引用

页码：847 / 857

页数：11

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