Hypertension：压力感受器刺激治疗对肾功能影响不大

颈动脉窦压力感受器刺激治疗（Baroreflex Activation Therapy，BAT）可有效的降低耐药性高血压患者的血压。而肾脏在长期血压调节中起着重要作用。长期BAT治疗对肾功能有何影响目前尚不清楚，荷兰的研究人员Alnima T等在Rheos Pivotal Trial研究的数据中分析长期治疗对肾功能的影响。

该共纳入322名患者。其中，组1中包含236例患者在压力感受器刺激装置植入1个月后开始刺激治疗，而组2的患者则在6个月后开始治疗。分别在刺激器激活前、第6个月和12个月测定血清肌酐和尿白蛋白/肌酐比。统计分析经多因素校正。治疗6个月后，组1中血清肌酐水平从78升至84 μmol/L，肾小球滤过率从92降至87mL/min 每1.73 m2（P<0.05）。到治疗的12个月，这些值未再发生进一步变化。肾小球滤过率最高的患者治疗后肾小球滤过降幅最大。组2的患者尽管6个月时刺激器并未工作但仍有和组1类似的趋势。两组患者中收缩压降低与肾小球滤过率变化明显相关。在随访中白蛋白/肌酐比值并未发生改变。

高血压患者压力感受器刺激治疗可导致肾小球滤过率轻度下降，可认为是血压下降所致的一个正常血流动力学表现。长期治疗并未导致肾功能下降，表明压力感受器刺激治疗安全有效。

Renal responses to long-term carotid baroreflex activation therapy in patients with drug-resistant hypertension.
Abstract
Carotid baroreflex activation has been demonstrated to provide enduring reductions in arterial blood pressure. The aim of this study was to investigate the effect of long-term therapy on renal function. A total of 322 patients were enrolled in the Rheos Pivotal Trial. Group 1 consisted of 236 patients who started baroreflex activation therapy 1 month after device implantation, whereas in the 86 patients from group 2 the device was activated 6 months later. Serum creatinine and urine albumin/creatinine ratio were collected at screening (before device activation), and at months 6 and 12. Multilevel statistical analyses were adjusted for various covariables. Serum creatinine increased from 78 to 84 μmol/L, and glomerular filtration rate decreased from 92 to 87 mL/min per 1.73 m(2) in group 1 at month 6 (P<0.05). These values did not change any further after 12 months of therapy. Patients with highest glomerular filtration rate showed the greatest decrease in glomerular filtration. Group 2 showed the same trends as group 1 even before device activation at month 6. Systolic blood pressure reduction seemed to be significantly related to the change in glomerular filtration rate in both groups. Albumin/creatinine ratio did not change in both groups during follow-up. In conclusion, baroreflex activation therapy in hypertensive patients is associated with an initial mild decrease in glomerular filtration rate, which may be considered as a normal hemodynamic response to the drop in blood pressure. Long-term treatment does not result in further decrease in renal function, indicating baroreflex activation as a safe and effective therapy.