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Veränderungen in der kardialen Morphologie und Funktion sowie des Glukosestoffwechsels nach Implantation eines Barorezeptorstimulators bei Patienten mit Therapie-refraktärer Hypertonie

dc.contributor.advisorWachter, Rolf Prof. Dr.
dc.contributor.authorSchroer, Leonie Charlotte
dc.date.accessioned2016-08-01T08:15:50Z
dc.date.available2016-08-09T22:50:05Z
dc.date.issued2016-08-01
dc.identifier.urihttp://hdl.handle.net/11858/00-1735-0000-0028-87E2-7
dc.identifier.urihttp://dx.doi.org/10.53846/goediss-5769
dc.identifier.urihttp://dx.doi.org/10.53846/goediss-5769
dc.language.isodeude
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject.ddc610de
dc.titleVeränderungen in der kardialen Morphologie und Funktion sowie des Glukosestoffwechsels nach Implantation eines Barorezeptorstimulators bei Patienten mit Therapie-refraktärer Hypertoniede
dc.typedoctoralThesisde
dc.title.translatedChanges of cardiac morphology and function and glucose metabolism after baroreceptor activation therapy in patients with resistant hypertensionde
dc.contributor.refereeWachter, Rolf Prof. Dr.
dc.date.examination2016-08-02
dc.description.abstractengPurpose: At this moment, baroreceptor activation therapy (BAT) is the only additional therapy to resistant hypertension that has been proved effective in a double blind, randomised, placebo-controlled trial. Data on the cardio-morphologic effects of this therapy have been published, still the performance and fitness of BAT patients under therapy was to be investigated. Methods: 33 Patients with resistant hypertension were included in this study. They all took three or more antihypertensive drugs, including a diuretic. Neither this nor life-style behaviours achieved satisfactory lowering of the elevated blood pressure level. Thus, they were implanted a Barostim neoTM device and examined at baseline and 6 months after BAT activation. In this prospective, non-randomised study, data were collected concerning the cardio-respiratory impact of BAT measured in a spiroergometric exercise, a 6-min walk test, BNP and an echocardiography. Adjustment of antihypertensive drugs was allowed by the treatment physician. Results: From 33 patients enrolled, 31 completed the 6 month visit. Comparing the blood pressure levels at baseline and six months after BAT activation, systolic blood pressure was significantly reduced (from 164.3±28.0 mmHg to 149.0±32.2 mmHg, p<0.01) while the diastolic values missed the significance level (from 85.4±17.4 mmHg to 77.7±18.8 mmHg, p=0.11). The number of antihypertensive drugs was reduced from 6.5±1.6 (baseline) to 6.1±1.7 (6 months) (p=0.045). The spiroergometric performance remained stable showing lower blood pressure levels but no changes in maximum work rate and peak VO2 (-0.7±15.1 Watt, p=0.84; -0.4±7.3 ml/min/kg, p=0.66). Similar results were shown in the 6 minute walk test (RRsyst post Belastung: -16.8±29.0, p=0.01; Distance: +11.9±51.3, p=0.25). No significant change in the left ventricular mass was found (-10.3±86.8 g, p=0.53) but the diastolic function was impaired following our classification (+0.28 units, p=0.04). The BNP remained stable (7.0±121.2 ng/l, p=0.46). Conclusion: Despite improvement of blood pressure in quiescence and stress BAT does neither impair fitness and performance nor cardiac hypertrophy or BNP. The missing amelioration of the diastolic function has to be observed further in the upcoming visits. Still, it is uncertain to which level diastolic function would have worsened without therapy. Thus suggesting that a randomised study on diastolic function is needed.de
dc.contributor.coRefereePatschan, Daniel Prof. Dr.
dc.subject.gerBarorezeptorstimulationstherapiede
dc.subject.gerTherapie refraktäre Hypertoniede
dc.subject.gerGlukosestoffwechselde
dc.subject.ger6 Minuten Gehtestde
dc.subject.gerDiastolische Funktionde
dc.subject.gerBNPde
dc.subject.gerSpiroergometriede
dc.subject.gerEchokardiogrammde
dc.subject.gerSystolische Funktionde
dc.subject.engBaroreceptor Activation Therapyde
dc.subject.engGlucose Metabolismde
dc.subject.engSpiroergometryde
dc.subject.eng6 minute hall walk testde
dc.subject.engDiastolic Functionde
dc.subject.engBNPde
dc.subject.engResistant Hypertensionde
dc.identifier.urnurn:nbn:de:gbv:7-11858/00-1735-0000-0028-87E2-7-9
dc.affiliation.instituteMedizinische Fakultätde
dc.subject.gokfullMedizin (PPN619874732)de
dc.description.embargoed2016-08-09
dc.identifier.ppn869468421


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