Evaluation zur Indikation einer Barorezeptor-Aktivierungstherapie an der Klinik für Nephrologie und Rheumatologie der Universitätsmedizin Göttingen. Eine retrospektive Studie der Jahre 2012 bis 2019.
by Tim Kuczera
Date of Examination:2023-04-25
Date of issue:2023-04-11
Advisor:Prof. Dr. Michael Koziolek
Referee:Prof. Dr. Michael Koziolek
Referee:Prof. Dr. Marco Schroeter
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EnglishUncontrolled hypertension is a main risk factor for cardiovascular morbidity. Baroreflex activation therapy (BAT) is an effective therapy option addressing true resistant hypertension. We evaluated patients' eligibility for BAT in a staged assessment as well as adherence to antihypertensive drug therapy. Therefore, we analyzed files of 345 patients, attending the hypertension clinic at University Medicine Göttingen. Additionally, gas chromatographic-mass spectrometric urine analyses of selected individuals were performed evaluating their adherence. Most common cause for a revoked BAT recommendation was blood pressure (BP) control by drug adjustment (54.2%). Second leading cause was presence of secondary hypertension (31.6%). Patients to whom BAT was recommended (59 (17.1%)) were significantly more often male (67.8% vs. 43.3%, P = .0063), had a higher body mass index (31.8 ± 5.8 vs. 30.0 ± 5.7 kg/m², P = .0436), a higher systolic office (168.7 ± 24.7 vs. 147.7 ± 24.1 mmHg, P < .0001), and 24h ambulatory BP (155.0 ± 14.6 vs. 144.4 ± 16.8 mmHg, P = .0031), took more antihypertensive drugs (5.8 ± 1.3 vs. 4.4 ± 1.4, P < .0001), and suffered more often from numerous concomitant diseases. Eventually, 27 (7.8%) received a BAT system. In the toxicological analysis of 75 patients, mean adherence was 75.1%. 16 patients (21.3%) showed non-adherence. Thus, only a small number of patients eventually received a BAT system, as treatable reasons for apparently resistant hypertension could be identified frequently. This study is-to our knowledge-the first report of a staged assessment of patients' suitability for BAT and underlines the need for a careful examination and indication. Non-adherence was proven to be a relevant issue concerning apparently resistant hypertension and therefore non-eligibility for interventional antihypertensive therapy.
Keywords: adherence; antihypertensive medication; baroreflex activation therapy; resistant hypertension; uncontrolled hypertension
Schlagwörter: Adhärenz; Barorezeptoraktivierungstherapie; therapieresistente arterielle Hypertonie; unkontrollierte arterielle Hypertonie; antihypertensive Therapie