[PP.10.03] SUCCESSFUL RENAL DENERVATION FOR RESISTANT HYPERTENSION FAILS TO IMPROVE INSULIN RESISTANCE AS ASSESSED BY HYPERINSULINEMIC EUGLYCEMIC STEP-CLAMP AND GLUCOSE TRACER INFUSION

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Abstract

Objective:

The purpose of this study was to determine whether insulin sensitivity is improved after successful renal denervation (RDN) treatment for resistant hypertension.

Design and method:

Non-randomized, prospective study of 23 non-diabetic patients with resistant hypertension undergoing a two-step hyperinsulinemic euglycemic clamp with glucose tracer and labeled glucose infusion (HEC) as well as an oral glucose tolerance test (OGTT) before and 6 months after RDN.

Design and method:

Whole body glucose disposal (WGD) and endoogenous glucose release (EGR) were calculated.

Results:

Eighteen of the 23 patients had metabolic syndrome at baseline, and body mass index (32 ± 5 kg/m2 at baseline) was stable during the study. At baseline, fasting plasma glucose was 5.9 ± 0.7 mmol/L, plasma insulin was 147 ± 93 pmol/L and plasma c-peptide was 1456 ± 502 pmol/L. No significant changes in these parameters were observed after 6 months. Basal glu-cose turnover rate and glucose infusion rate during two-step clamping remained unchanged. Suppression of endogenous glucose release during low-dose insulin infusion decreased from 0.9 ± 0.4 to 0.8 ± 0.4 mg/kg/min (p = 0.02), but remained unchanged during high insulin infu-sion. Area under the curve 0–120 min for glucose and insulin during OGTT, homeostasis model assessment-insulin resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (ISQUICKI), the Simple Index assessing Insulin Sensitivity oral glucose tolerance (SIisOGTT) did not change significantly.

Results:

Whole body glucose disposal did not change from basal levels at follow-up (Figure 1).

Conclusions:

Despite a significant effect on blood pressure, RDN treatment did not improve peripheral or hepatic insulin sensitivity, in this group of non-diabetic patients with resistant hypertension, as assessed by two-step HEC with glucose tracer infusion as well as indices derived from OGTT and fasting blood samples 6 months after RDN.

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