Effect of Renal Sympathetic Denervation on Glucose Metabolism in Patients With Resistant Hypertension A Pilot Study

Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Circulation (Impact Factor: 14.43). 05/2011; 123(18):1940-6. DOI: 10.1161/CIRCULATIONAHA.110.991869
Source: PubMed


Hypertension is associated with impaired glucose metabolism and insulin resistance. Chronic activation of the sympathetic nervous system may contribute to either condition. We investigated the effect of catheter-based renal sympathetic denervation on glucose metabolism and blood pressure control in patients with resistant hypertension.
We enrolled 50 patients with therapy-resistant hypertension. Thirty-seven patients underwent bilateral catheter-based renal denervation, and 13 patients were assigned to a control group. Systolic and diastolic blood pressures, fasting glucose, insulin, C peptide, hemoglobin A(1c), calculated insulin sensitivity (homeostasis model assessment-insulin resistance), and glucose levels during oral glucose tolerance test were measured before and 1 and 3 months after treatment. Mean office blood pressure at baseline was 178/96±3/2 mm Hg. At 1 and 3 months, office blood pressure was reduced by -28/-10 mm Hg (P<0.001) and -32/-12 mm Hg (P<0.001), respectively, in the treatment group, without changes in concurrent antihypertensive treatment. Three months after renal denervation, fasting glucose was reduced from 118±3.4 to 108±3.8 mg/dL (P=0.039). Insulin levels were decreased from 20.8±3.0 to 9.3±2.5 μIU/mL (P=0.006) and C-peptide levels from 5.3±0.6 to 3.0±0.9 ng/mL (P=0.002). After 3 months, homeostasis model assessment-insulin resistance decreased from 6.0±0.9 to 2.4±0.8 (P=0.001). Additionally, mean 2-hour glucose levels during oral glucose tolerance test were reduced significantly by 27 mg/dL (P=0.012). There were no significant changes in blood pressure or metabolic markers in the control group.
Renal denervation improves glucose metabolism and insulin sensitivity in addition to a significantly reducing blood pressure. However, this improvement appeared to be unrelated to changes in drug treatment. This novel procedure may therefore provide protection in patients with resistant hypertension and metabolic disorders at high cardiovascular risk.
URL: Unique identifiers: NCT00664638 and NCT00888433.

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Available from: Lars Christian Rump, Jul 27, 2015
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    • "Based on mostly small, purely observational studies, RDN was associated with ancillary benefits such as decreased left ventricular mass [23], arterial stiffness [24], heart rate and atrioventricular conduction [25, 26], arrhythmia burden [27], renal resistive indices [28] and albuminuria [29], as well as with improved cardiac function [23], central hemodynamics [24] and insulin sensitivity [30]. Furthermore, it was proposed as a potential treatment in a host of medical conditions, including chronic kidney disease [31], atrial fibrillation [32], heart failure [33], obstructive sleep apnoea [34] and polycystic ovary syndrome [35]. "
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    ABSTRACT: After three years of excessive confidence, overoptimistic expectations and performance of 15 to 20,000 renal denervation procedures in Europe, the failure of a single well-designed US trial-Symplicity HTN-3-to meet its primary efficacy endpoint has cast doubt on renal denervation as a whole. The use of a sound methodology, including randomisation and blinded endpoint assessment was enough to see the typical 25-30 mmHg systolic blood pressure decrease observed after renal denervation melt down to less than 3 mmHg, the rest being likely explained by Hawthorne and placebo effects, attenuation of white coat effect, regression to the mean and other physician and patient-related biases. The modest blood pressure benefit directly assignable to renal denervation should be balanced with unresolved safety issues, such as potentially increased risk of renal artery stenosis after the procedure (more than ten cases reported up to now, most of them in 2014), unclear long-term impact on renal function and lack of morbidity-mortality data. Accordingly, there is no doubt that renal denervation is not ready for clinical use. Still, renal denervation is supported by a strong rationale and is occasionally followed by major blood pressure responses in at-risk patients who may otherwise have remained uncontrolled. Upcoming research programmes should focus on identification of those few patients with truly resistant hypertension who may derive a substantial benefit from the technique, within the context of well-designed randomised trials and independent registries. While electrical stimulation of baroreceptors and other interventional treatments of hypertension are already "knocking at the door", the premature and uncontrolled dissemination of renal denervation should remain an example of what should not be done, and trigger radical changes in evaluation processes of new devices by national and European health authorities.
    Current Hypertension Reports 08/2014; 16(8):460. DOI:10.1007/s11906-014-0460-x · 3.44 Impact Factor
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    • "Radiofrequency energy is being used due to the property of superficial and deep tissue destruction. Currently, nonirrigated [4] [5] [7] or irrigated [9] [10] catheters have been used, safely and effectively. In contrast to the use of fixed-curve sheath in a previous study from our group [9], we observed that the long steerable sheath demonstrated utmost facility at anchoring its tip at the ostia of renal arteries, allowing greater flexibility in positioning the ablation catheter. "
    International journal of cardiology 04/2014; 174(2). DOI:10.1016/j.ijcard.2014.04.048 · 4.04 Impact Factor
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    • "Glucose, after two hours of stimulation, also improved after the procedure, with a decrease of 27 mg/dl compared to baseline. There were no changes on BP and metabolic parameters in the control group25. "
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    ABSTRACT: The authors review the concept of resistant hypertension and the involvement of the sympathetic nervous system in hypertension as a rational basis for the technique of renal sympathetic denervation (RSD) performed percutaneously. This revision is the result of an active search for scientific articles with the term "renal denervation" in the Medline and PubMed databases. The techniques and devices used in the procedure are presented, as well as clinical outcomes at six, 12 and 24 months after the intervention with the Symplicity catheter. Significant decreases and progressively higher reductions of systolic and diastolic blood pressure were observed after RSD. The complication rate was minimal. New devices for RSD and its ongoing clinical studies are cited. In conclusion, the RSD presents itself as an effective and safe approach to resistant hypertension. Results from ongoing studies and longer follow-up of these patients are expected to confirm the initial results and put into perspective the expansion of the procedure use in hypertension approach.
    Arquivos brasileiros de cardiologia 09/2013; 101(4). DOI:10.5935/abc.20130187 · 1.02 Impact Factor
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