To evaluate long-term effect of catheter-based renal denervation (RDN) on glucose metabolism and blood pressure control in patients with resistant hypertension and diabetes mellitus type 2.Design and method:
Thirty two patients with true resistant hypertension and type 2 diabetes mellitus were included in single-arm prospective interventional study (detailed protocol was published on ClinicalTrial.gov, number NCT01499810). Office blood pressure (BP) measurement, ambulatory 24-h BP, HbA1c, basal and postprandial plasma levels of glucose, insulin and C-peptide with calculation of Homeostasis Model Assessment (HOMA) index were performed at baseline and 12 months after RDN. On average, patients were taking 4 (3–6) antihypertensive drugs. None of the patients changed the antihypertensive treatments during follow-up. A 12 months follow-up was completed by 26 patients (43–75 years old, mean aged 59.3 ± 7.9 years, 14 male).Results:
Mean 24-hour systolic BP (SBP) changed from 157 (145–169) mmHg to 144 (131–163) mmHg (p = 0.01) without any negative effect on renal function. There were 61.5% (n = 16) responders with 24h- SPB reduction > 10mmHg. Overall, there were no significant changes in mean values C-peptide, insulin levels and HOMA-index (P > 0.05) after RDN. However, there was a reduction in all measures of insulin resistance, including HbA1C, fasting glucose, postprandial insulin and C-peptide levels and HOMA-index in responders and increasing those in non-responders (-0.12 ± 0.98 vs 1.26 ± 1.11, P = 0.04 for HbA1c; -0.89 ± 1.9 vs 0.85 ± 1.19, P = 0.02 for basal glucose; −1.24 (−1.95; −0.05) vs 1.23 (0.91–4.05), P = 0.01 for postprandial C-peptide level; −0.43 (−17.28; 1.80) vs 30.23 (9.75–65.72), P = 0.001 for postprandial insulin levels; −0.67 (−1.49; −0.61) vs 2.47 (0,21–5.98), p = 0.02 for HOMA-index).Conclusions:
Effective renal sympathetic denervation with proven BP effect (reduction SBP- 24 hour > 10 mmHg) increases insulin sensitivity and improves glucose metabolism in patients with resistant hypertension and diabetes mellitus type 2.