Renal sympathetic denervation, potential effects on blood pressure and glucose metabolism in patients with severe treatment resistant hypertension. The Re-shape CV-risk study
Background: Denervation of renal sympathetic nerves (RDN) is a mini-invasive endovascular procedure introduced as an antihypertensive treatment with a potentially beneficial effect on insulin resistance. In this open-label non-randomized study we investigated non-diabetic patients with true treatment-resistant hypertension defined as office systolic blood pressure (BP)>140 mmHg and (mean) daytime (ambulatory) BP >135 mmHg, despite four or more antihypertensive drugs.
Methods: Bilateral RDN was performed with the Symplicity Catheter System (N=23), and patients were followed- for six and 24 months. BP measurements were performed after witnessed intake of antihypertensive drugs. BP variability and arterial stiffness indices were calculated from 24-hour BP recordings. Insulin sensitivity was assessed using a two-step hyperinsulinemic- euglycemic clamp with glucose tracer before and six months after RDN. Oral glucose tolerance test, levels of insulin, C-peptide, adiponectin and leptin were measured and surrogate insulin resistance indices were calculated before RDN and during follow-up.
Results: Most of the patients were obese, had metabolic syndrome and severe insulin resistance at baseline. We found a statistically significant reduction of both office and ambulatory 24-hour BP as well as BP variability six months after RDN. Despite decline in BP, neither peripheral nor hepatic insulin sensitivity improved six months after RDN. Twenty patients continued to the two-year follow up. Some rebound in BP was found in most of patients. Arterial stiffness did not change during follow-up. All measured metabolic variables and insulin resistance surrogate indices remained essentially unaltered two years after RDN.
Conclusion: Neither peripheral nor hepatic insulin sensitivity improved after RDN. Our study does not support the notion of a beneficial metabolic effect of RDN in patients with treatment resistant hypertension.
Paper I: Miroslawska, A., Solbu, M., Skjølsvik, E., Toft, I. & Steigen, T.K. (2016). Renal sympathetic denervation: effect on ambulatory blood pressure and blood pressure variability in patients with treatment-resistant hypertension. The Re-Shape CV-risk study. Journal of Human Hypertension, 30(3), 153-157. Also available at https://doi.org/10.1038/jhh.2015.69.
Paper II: Miroslawska, A.K., Gjessing, P.F., Solbu, M.D., Fuskevåg, O.M., Jenssen, T.G. & Steigen T.K. (2016). Renal Denervation for Resistant Hypertension Fails to Improve Insulin Resistance as Assessed by Hyperinsulinemic-Euglycemic Step Clamp. Diabetes, 65(8), 2164-2168. Reprinted with permission from The American Diabetes Association. Copyright 2016 American Diabetes Association. Also available at https://doi.org/10.2337/db16-0205.
Paper III: Miroslawska, A.K., Gjessing, P.F., Solbu, M.D., Norvik, J.V., Fuskevåg, O.M., Hanssen, T.A. & Steigen, T.K. (2021). Metabolic effects two years after renal denervation in insulin resistant hypertensive patients. The Re-Shape CV-risk study. Clinical Nutrition, 40(4), 1503-1509. Also available at https://doi.org/10.1016/j.clnu.2021.02.027.
PublisherUiT The Arctic University of Norway
UiT Norges arktiske universitet
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