Nous rapportons l’expérience du centre hospitalo-universitaire de Lyon concernant la dénervation rénale pour le traitement de l’hypertension artérielle résistante. Sur une période d’un an, 17 patients (12 hommes/5 femmes) ont été traités par une procédure de dénervation rénale. L’âge moyen était de 56,5 ± 11,5 ans, l’indice de masse corporelle (IMC) de 33 ± 5 kg/m2 et la mesure ambulatoire de la pression artérielle (MAPA) des 24 heures de 157 ± 16/87 ± 13 mmHg avec en moyenne 4,2 ± 1,5 traitements anti-hypertenseurs. Nous n’avons pas observé de complications péri- ou postopératoires dans notre cohorte. Après un suivi médian de 3 mois et un nombre de traitements anti-hypertenseurs stable (n = 4,2 ± 1,2), la baisse de pression artérielle obtenue en consultation est en moyenne de 20 ± 15 mmHg (p < 0,001) pour la pression artérielle systolique et de 10 ± 13 mmHg (p = 0,014) pour la pression artérielle diastolique à 1 mois (n = 17). Pour les 6 patients dont le suivi est supérieur à 3 mois, la baisse de pression artérielle obtenue sur la MAPA des 24 heures est 17,5 ± 14,9 (p = 0,027) pour la systolique et 10,5 ± 9,6 (p = 0,029) pour la diastolique. Cinq des 6 patients ont une MAPA des 24 heures contrôlée <130/80 mmHg et nous observons une diminution des signes d’hypertrophie ventriculaire gauche électriques : diminution de l’onde R en aVL de 4 ± 3 mm (p = 0,031), de l’index de Sokolow de 3 ± 3 mm (p = 0,205), de l’index de Cornell de 9 ± 7 mm (p = 0,027) et du produit du Cornell de 1310 ± 1104 (p = 0,027). Nos résultats sont en accord avec les données observées dans les autres centres. La réponse manométrique est significative, mais la variation interindividuelle est importante. La sécurité de la technique est acceptable. We report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension. Over a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5 ± 11.5 years, BMI 33 ± 5 kg/m2 and ambulatory blood pressure 157 ± 16/87 ± 13 mmHg with 4.2 ± 1.5 anti-hypertensive treatment. We did not observe per procedural and early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20 ± 15 (P < 0.001) and 10 ± 13 mmHg (P = 0.014) (n = 17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5 ± 14.9 mmHg (P = 0.027) for SBP and of 10.5 ± 9.6 mmHg (P = 0.029) for DBP (n = 6). Among these patients, five of them were controlled (ABPM inferior to 130/80 mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4 ± 3 mm (P = 0.031), Sokolow index of 3 ± 3 mm (P = 0.205), Cornell voltage criterion of 9 ± 7 mm (P = 0.027) and Cornell product of 1310 ± 1104 (P = 0.027). Our results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe.

AIM:We report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension. PATIENTS AND METHODS:Over a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5±11.5 years, BMI 33±5kg/m(2) and ambulatory blood pressure 157±16/87±13mmHg with 4.2±1.5 anti-hypertensive treatment. RESULTS:We did not observe intra-operative or early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20±15 (P<0.001) and 10±13mmHg (P=0.014) (n=17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5±14.9mmHg (P=0.027) for SBP and of 10.5±9.6mmHg (P=0.029) for DBP (n=6). Among these patients, five of them were controlled (ABPM inferior to 130/80mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4±3mm (P=0.031), Sokolow index of 3±3mm (P=0.205), Cornell voltage criterion of 9±7mm (P=0.027) and Cornell product of 1310±1104 (P=0.027). CONCLUSION:Our results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe.

<正>该研究收集高血压患者426例,年龄(51.2±13.8)岁,收缩压(155.6±21.1)mmHg(1mmHg=0.133kPa)。根据4种不同路径评估法(直接、实时、减去、估计),分别计算4次颈股动脉脉搏波传导速度(pulse wave velocity,PWV)。观测全因死亡和主要心血管事件发病率。采用C指数分析PWV预测的准

Carotid-femoral pulse wave velocity (PWV) has become an important tool for risk stratification as acknowledged by the 2007 ESC-ESH guidelines. An important limitation relies to the measurement of the distance travelled by the pulse wave. Weber et coll. have recently suggested that an estimation (estim) based on body height (height/4 + 7.28 cm)* might be better than the classical direct carotid-femoral (CF) distance measurement (meas). The present study sought to compare the prognostic value of PWVmeas and PWVestim. As recommended by the guidelines, a 12 m/s threshold was used for PWVmeas and PWVestim. In 568 consecutive hypertensive patients referred to our department for hypertension work-up (47 % women, mean ± SD, age 53 ± 14 yrs, 24-hour systolic BP 152 ± 21 mmHg), PWV was measured with a Complior. Mortality was assessed through a questionnaire and through the office of Civil registration after a mean duration of 5.3 years till death or censoring date. During that period, 26 deaths occurred. PWVmeas (13 ± 3.0 m/s) and PWVestim (9.3 ± 2.2 m/s) were highly correlated (r = 0.938, p < 0.001) and the area under the ROC curves for total mortality were very similar (0.76 vs 0.75, respectively). The figure shows the survival curves adjusted for age in the 2 groups of PWV defined by the 12 m/s threshold. A significant difference of prognosis (p < 0.05) was only noticed for PWVestim but not for PWVmeas.This study confirmed the impact of the travel distance determination on PWV calculation and on its prognostic value. A 12 m/s threshold doesn't seem appropriate when the CF distance is taken into account while it retains a prognostic significance when the distance is estimated from body height. Further advantages of distance estimation are simplicity and reproducibility which all represent strong arguments to favour its use for routine use.

N-terminal pro brain natriuretic peptide (NT-proBNP) is a validated marker of risk in heart failure and in acute coronary syndrome. In hypertension, NT-proBNP is related to left ventricular hypertrophy (LVH) and has even been proposed as a diagnostic test for this condition. On the contrary, very few data are available concerning its prognostic value beyond traditional risk factors. Thus, the present study aimed at examining the relation of NT-proBNP with total mortality. In 691 consecutive hypertensive patients free of heart failure, referred to our department for hypertension work-up (47% women, mean age ± SD, 52 ± 14 yrs, 24-hour systolic BP, 152 ± 21 mmHg, 15% with LVH by EKG), NT-proBNP was measured (232 ± 804 pg/ml) and analysed after dividing by tertiles of NT-proBNP: Tertile 1 (<50.8 pg/ml); Tertile 2 (50.8 - 132 pg/ml); Tertile 3 (>132 pg/ml) or according to a threshold used for LVH diagnosis (111pg/mL for men and 144pg/mL for women). Mortality was assessed through a questionnaire and through the office of Civil registration after a mean duration of 5.7 years till death or censoring date. During that period, 40 deaths occurred. The figure shows the Kaplan-Meier survival curves for the 3 tertiles. Of note is the significantly poorer prognosis attached to Tertile 2 relative to Tertile 1 (log-rank test, p = 0.037), Tertile 3 relative to Tertile 2 (log-rank test, p = 0,013) and Tertile 3 relative to Tertile 1 (log-rank test, p < 0,001). The result is similar for the division into two groups (log rank test, p < 0,001). In a Cox analysis including age, 24-hour systolic BP, diabetes, smoking, hypercholesterolemia as potential confounders, the NT-proBNP retained a significant independent prognostic value (p < 0.01). Adding proteinuria and Sokolov index to the model did not change the results. Based on these results, NT-proBNP appears as a valuable prognostic marker in hypertension and should be used as a simple tool for risk stratification.