title: Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  URL: http://www.ClinicalTrials.gov. Unique identifiers: NCT00664638 and NCT00888433.
authors.affiliation: Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. felix.mahfoud@uks.eu
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Markus
authors.initials: M
authors.lastname: Schlaich
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kindermann
authors.forename: Christian
authors.initials: C
authors.lastname: Ukena
authors.forename: Bodo
authors.initials: B
authors.lastname: Cremers
authors.forename: Mathias C
authors.initials: MC
authors.lastname: Brandt
authors.forename: Uta C
authors.initials: UC
authors.lastname: Hoppe
authors.forename: Oliver
authors.initials: O
authors.lastname: Vonend
authors.forename: Lars C
authors.initials: LC
authors.lastname: Rump
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Murray
authors.initials: M
authors.lastname: Esler
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000378:metabolism; D004351:Drug Resistance; D005260:Female; D018149:Glucose Intolerance / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy / Q000378:metabolism* / Q000601:surgery*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D007668:Kidney / Q000294:innervation* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013562:Sympathectomy / Q000379:methods*; D013564:Sympathetic Nervous System / Q000378:metabolism / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents