title: Renal Denervation for Resistant Hypertension Fails to Improve Insulin Resistance as Assessed by Hyperinsulinemic-Euglycemic Step Clamp.
abstract: We assessed whether insulin sensitivity improved after renal denervation (RDN) for resistant hypertension. Twenty-three patients underwent a two-step hyperinsulinemic-euglycemic clamp (HEC) with glucose tracer and labeled glucose infusion and oral glucose tolerance test (OGTT) before and 6 months after RDN. Eighteen patients had metabolic syndrome at baseline. Blood pressure declined significantly after RDN, whereas mean (SD) fasting plasma glucose concentration (5.9 ± 0.7 mmol/L), median (minimum-maximum) insulin concentration (254 pmol/L [88-797 pmol/L]), and median C-peptide concentration (2.4 nmol/L [0.9-5.7 nmol/L]) remained unchanged. Endogenous glucose release during HEC was less suppressed after RDN, suggesting a slight decrease in hepatic insulin sensitivity. During high-dose insulin infusion, whole-body glucose disposal was low and remained unchanged after RDN, indicating persistent peripheral insulin resistance (IR). Area under the curve for 0-120 min for glucose and insulin during OGTT, Quantitative Insulin Sensitivity Check Index, Simple Index Assessing Insulin Sensitivity Oral Glucose Tolerance, and HOMA-IR were high, and did not improve after RDN. Despite a significant decrease in blood pressure, neither peripheral nor hepatic insulin sensitivity improved 6 months after RDN treatment in this group of insulin-resistant patients without diabetes and with resistant hypertension, as measured with gold standard methods.
authors.affiliation: Department of Cardiology, University Hospital of North Norway, Tromsø, Norway Cardiovascular Diseases Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Atena K
authors.initials: AK
authors.lastname: Miroslawska
authors.affiliation: Gastrosurgery Research Group, UiT The Arctic University of Norway, Tromsø, Norway Department of Digestive Surgery, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Petter F
authors.initials: PF
authors.lastname: Gjessing
authors.affiliation: Section of Nephrology, University Hospital of North Norway, Tromsø, Norway Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Marit D
authors.initials: MD
authors.lastname: Solbu
authors.affiliation: Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Ole M
authors.initials: OM
authors.lastname: Fuskevåg
authors.affiliation: Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway Department of Organ Transplantation, University Hospital of Oslo Rikshospitalet, Oslo, Norway.
authors.forename: Trond G
authors.initials: TG
authors.lastname: Jenssen
authors.affiliation: Department of Cardiology, University Hospital of North Norway, Tromsø, Norway Cardiovascular Diseases Research Group, UiT The Arctic University of Norway, Tromsø, Norway terje.steigen@unn.no.
authors.forename: Terje K
authors.initials: TK
authors.lastname: Steigen
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002096:C-Peptide / Q000378:metabolism; D003714:Denervation; D005215:Fasting / Q000097:blood; D005260:Female; D005947:Glucose / Q000378:metabolism; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D005947:Glucose