title: Denervation of the renal arteries in metabolic syndrome: the DREAMS-study.
abstract: Chronic elevation of sympathetic nervous system is a key factor in metabolic syndrome. Because renal denervation (RDN) is thought to modulate sympathetic activity, we performed the Denervation of the Renal Arteries in Metabolic Syndrome (DREAMS)-study to investigate the effects of RDN on insulin sensitivity and blood pressure (BP) in patients with metabolic syndrome. Twenty-nine patients fulfilling the criteria for metabolic syndrome and who used a maximum of 1 antihypertensive or 1 antidiabetic drug or 1 of both gave informed consent and were treated by RDN. Glucose tolerance tests and 24-hour ambulatory BP measurements were performed at baseline, at 6 and 12 months of follow-up. Moreover, we performed self-monitored BP measurements at home every month. To assess sympathetic activity, we performed muscle sympathetic nerve activity and heart rate variability measurements at baseline and follow-up. The majority of the included patients was men (57%), mean body mass index was 31±5 kg/m(2). Median insulin sensitivity as assessed by the Simple Index assessing Insulin Sensitivity oral glucose tolerance test did not change at 6- and 12-month follow-up (P=0.60 and P=0.77, respectively). Mean 24-hour BP decreased by 6±12/5±7 mm Hg 12 months after RDN (P=0.04/0.01). However, self-monitored BP measurements data showed no reduction over time. Measurements of sympathetic activity showed no reduction in systemic sympathetic activity. In conclusion, RDN did not lead to a significant improvement of insulin sensitivity ≤12 months after treatment. Although a significant reduction in ambulatory BP was observed in this nearly drug-naïve population, the self-monitored BP measurements data suggest that this may be explained by regression to the mean. Moreover, no effect in systemic sympathetic activity was observed.
authors: From the Departments of Cardiology (W.L.V., M.M.A.B., P.A.D., M.V.), Vascular Medicine (W.S.), and Nephrology (E.E.V., P.J.B.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Willemien L
authors: WL
authors: Verloop
authors: From the Departments of Cardiology (W.L.V., M.M.A.B., P.A.D., M.V.), Vascular Medicine (W.S.), and Nephrology (E.E.V., P.J.B.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Wilko
authors: W
authors: Spiering
authors: From the Departments of Cardiology (W.L.V., M.M.A.B., P.A.D., M.V.), Vascular Medicine (W.S.), and Nephrology (E.E.V., P.J.B.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Eva E
authors: EE
authors: Vink
authors: From the Departments of Cardiology (W.L.V., M.M.A.B., P.A.D., M.V.), Vascular Medicine (W.S.), and Nephrology (E.E.V., P.J.B.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Martine M A
authors: MM
authors: Beeftink
authors: From the Departments of Cardiology (W.L.V., M.M.A.B., P.A.D., M.V.), Vascular Medicine (W.S.), and Nephrology (E.E.V., P.J.B.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Peter J
authors: PJ
authors: Blankestijn
authors: From the Departments of Cardiology (W.L.V., M.M.A.B., P.A.D., M.V.), Vascular Medicine (W.S.), and Nephrology (E.E.V., P.J.B.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Pieter A
authors: PA
authors: Doevendans
authors: From the Departments of Cardiology (W.L.V., M.M.A.B., P.A.D., M.V.), Vascular Medicine (W.S.), and Nephrology (E.E.V., P.J.B.), University Medical Center Utrecht, Utrecht, The Netherlands. m.voskuil@umcutrecht.nl.
authors: Michiel
authors: M
authors: Voskuil
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D007668:Kidney / Q000294:innervation*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013562:Sympathectomy / Q000379:methods*; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: blood pressure; insulin resistance; metabolic syndrome X; renal denervation; sympathetic nerve activity