Orlando， FL – 在第58届ACC年会又提出了一项有效降低难治性高血压患者收缩压的新方法。经过两年关于 Rheos®装置治疗高血压病的研究，研究者发现置入这种脉冲式发生装置，可以有效刺激颈动脉窦压力感受器，从而降低顽固性高血压患者的收缩压。

    有些高血压患者尽管进行了严格的药物治疗，血压仍难以控制，这严重威胁了患者的健康。研究者想通过这项长期研究确定初步的观察与置入Rheos®装置的关系，从而向难治性高血压患者提供了一种可以替代药物的治疗。

    来自华盛顿大学医学院的 Marcos Rothstein 教授说：“这种装置的优点之一就是它可以根据病人的自然节奏控制血压。比如说，在睡眠中装置自然就把血压降低了10-15个点。它与起搏器的原理相似，只是不是置入心脏，而是安装在颈动脉窦周围。如果一种新的降压药可以使血压降低3-5mmHg，大家就认为它很有效。而这种装置可以使血压平均降低20mmHg，这完全是短期内降压的一次重大改革。”

    这项研究入选了61名患者，他们至少是高血压病2级并对3种或更多降压药物都发生抵抗（其中包括利尿剂），随机分成两组进行研究。

    Rheos®装置先通过手术置入人体，1个月后激活，3个月后就可以有效降压，1-2年后后续的激活作用就确定了。来自9个研究中心的38名患者完成了2年的Rheos®装置的治疗，22名患者完成了用时3年的Rheos®装置治疗。

    在应用Rheos®装置2年后，53%的患者收缩压下降20mmHg，26%的患者收缩压降到了140mmHg以下。左室质量指数(- 25 g/m2， P < 0.001)在1年内也有了明显的改进。没有未预测到的严重中的不良反应事件发生。

    Rothstein 教授指出，美国有2500万高血压患者血压难以控制或未接受治疗，还有100万患者患有严重而持续的高血压，药物治疗对他们无效。这些患者联用多种降压药治疗，但收缩压仍持续在160mmHg以上。他们发生早亡、中风、心脏病或肾病的风险最高，因此需要一种新方法来治疗高血压。

（陈维君 吕树铮  首都医科大学附属北京安贞医院）

英文原文：
IMPLANTABLE DEVICE LOWERS MEDICALLY REFRACTORY HYPERTENSION
Implantable Device Activates Baroreceptors in the Carotid Sinus to Produce Significant Reductions in Blood Pressure

Orlando， FL – Two years of chronic treatment with the Rheos® Hypertension System， an implantable pulse generator that activates baroreceptors of the carotid sinus， produced significant reductions in systolic blood pressure in patients with refractory hypertension， according to research presented today at the American College of Cardiology’s 58th annual scientific session.

Hypertension that remains uncontrolled despite optimal medical treatment is a serious health threat for patients. This long-term study sought to confirm initial observations that were seen with the Rheos® system， which represents an alternative to pharmacological therapy for refractory hypertensive patients.

“One of the virtues of this device is that it allows the patient to control the rhythms of blood pressure as they occur naturally. For instance， during sleep the blood pressure goes down 10 to 15 points and this device takes this into account. It is a new take on the principle of a pacemaker， but instead of being installed in the heart， it is wrapped around the carotid sinus，” said Marcos Rothstein， M.D.， professor of medicine at Washington University School of Medicine， St. Louis， M.O. “When a new antihypertensive agent comes on the market and drops the blood pressure three or five mmHg， it is considered a successful drug. This device， on average， drops the blood pressure 20 mmHg. This is nothing short of revolutionary in the treatment of hypertension.”

Sixty-one patients with stage II hypertension (≥ 160 mmHg systolic) resistant to three or more antihypertensive medications including a diuretic， were enrolled in two non-randomized studies.

The Rheos device was surgically implanted and then activated one month later， and efficacy at three months， one year and two years post-activation was determined. A cohort of 38 patients from nine centers completed two years of chronic device therapy， and a cohort of 22 patients completed three years of chronic device therapy.

After two years， a reduction in systolic blood pressure greater than 20 mmHg was achieved in 53 percent of patients， and 26 percent achieved a systolic blood pressure less than 140 mmHg. A significant improvement in left ventricular mass index (- 25 g/m2， P < 0.001) was also observed at one year. No unexpected serious adverse events occurred.

“Upwards of 25 million Americans have uncontrolled or untreated hypertension and of that number， easily about one million will have severe， persistent hypertension that is not amenable to the usual medical therapy. These patients have maxed out on standard antihypertensive therapy and still have systolic blood pressures consistently above 160 mmHg，” Rothstein said. “They have the highest possible risk for early death， strokes， heart attacks and kidney disease. These patients need an entirely new approach to treat their hypertension.”