title: Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea.
abstract: Percutaneous renal sympathetic denervation by radiofrequency energy has been reported to reduce blood pressure (BP) by the reduction of renal sympathetic efferent and afferent signaling. We evaluated the effects of this procedure on BP and sleep apnea severity in patients with resistant hypertension and sleep apnea. We studied 10 patients with refractory hypertension and sleep apnea (7 men and 3 women; median age: 49.5 years) who underwent renal denervation and completed 3-month and 6-month follow-up evaluations, including polysomnography and selected blood chemistries, and BP measurements. Antihypertensive regimens were not changed during the 6 months of follow-up. Three and 6 months after the denervation, decreases in office systolic and diastolic BPs were observed (median: -34/-13 mm Hg for systolic and diastolic BPs at 6 months; both P<0.01). Significant decreases were also observed in plasma glucose concentration 2 hours after glucose administration (median: 7.0 versus 6.4 mmol/L; P=0.05) and in hemoglobin A1C level (median: 6.1% versus 5.6%; P<0.05) at 6 months, as well as a decrease in apnea-hypopnea index at 6 months after renal denervation (median: 16.3 versus 4.5 events per hour; P=0.059). In conclusion, catheter-based renal sympathetic denervation lowered BP in patients with refractory hypertension and obstructive sleep apnea, which was accompanied by improvement of sleep apnea severity. Interestingly, there are also accompanying improvements in glucose tolerance. Renal sympathetic denervation may conceivably be a potentially useful option for patients with comorbid refractory hypertension, glucose intolerance, and obstructive sleep apnea, although further studies are needed to confirm these proof-of-concept data.
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. witkowski@hbz.pl
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Florczak
authors.forename: Jacek
authors.initials: J
authors.lastname: Kądziela
authors.forename: Paweł
authors.initials: P
authors.lastname: Śliwiński
authors.forename: Przemysław
authors.initials: P
authors.lastname: Bieleń
authors.forename: Ilona
authors.initials: I
authors.lastname: Michałowska
authors.forename: Marek
authors.initials: M
authors.lastname: Kabat
authors.forename: Ewa
authors.initials: E
authors.lastname: Warchoł
authors.forename: Magdalena
authors.initials: M
authors.lastname: Januszewicz
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Narkiewicz
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology*; D017115:Catheter Ablation; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000294:innervation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose