gms | German Medical Science

27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga

Deutsche Liga zur Bekämpfung des hohen Blutdrucks – Deutsche Hypertonie Gesellschaft e. V.

26. bis 29.11.2003, Bonn

Entfernung agonistischer Antikörper gegen den alpha1-Rezeptor bei Patienten mit therapierefraktärer Hypertonie: eine Pilotstudie

Agonistic antibodies against the alpha1-receptor in patients with refractory hypertension and their removal by immun

Meeting Abstract (Hypertonie 2003)

  • presenting/speaker V. Homuth
  • C. Stabroth
  • G. Wallukat
  • C. Schroeder
  • R. Dechend
  • J. Jordan
  • F. Luft

Hypertonie 2003. 27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga. Bonn, 26.-29.11.2003. Düsseldorf, Köln: German Medical Science; 2004. Doc03hochV37

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/hoch2003/03hoch037.shtml

Veröffentlicht: 11. November 2004

© 2004 Homuth et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background

Refractory hypertension (RH) has a poor prognosis and oftentimes leads to cardiovascular complications and death within a few years. Hypertension is considered refractory if blood pressure cannot be reduced to below 140/90 mmHg in patients who adhere to an adequate and appropriate three-to-four drug regimen. We found autoantibodies against the alpha1-adrenoreceptor (AAB) in 46 of 59 (78%) patients with RH. The AAB activate alpha1-adrenoreceptors in vitro and may increase vascular tone.

Methods

We determined the feasibility and safety to remove AAB in four patients with RH (3 males, 1 female (60±4 yrs, BMI 29±1 kg/m2)). Patients were off antiadrenergic medications. All other antihypertensive medications were kept constant throughout the study. A large antecubital venous catheter was inserted in each arm. The patients underwent immune adsorption (IA) by adsorption columns (Globaffin, Affina Immuntechnik, Germany) on five consecutive days. Levels of AAB were measured by a bioassay using spontaneously beating rat cardiomyocytes. Brachial blood pressure and heart rate (Dinamap) were monitored before, during, and 5 to 12 days after IA.

Results

IA was well tolerated by all patients. AAB were substantially reduced by the intervention (24±2 ?bpm/min before vs. 5±2 ?bpm/min after IA, p<0.01). Prior to IA, blood pressure and heart rate during 30 min of supine rest were 172±14 /86±8 mmHg and 58±6 bpm, respectively. We did not observe an acute change in blood pressure during the IA sessions. However, after completion of the IA protocol, blood pressure was significantly reduced (149±13 /78±4 mmHg, p<0.05). Heart rate did not change significantly with IA.

Conclusions

In patients with refractory hypertension, autoantibodies against the alpha1-adrenoreceptor can be effectively removed by immune adsorption. Removal of the antibodies might have a beneficial effect on blood pressure in these patients.