Long-term outcomes of renal denervation in the treatment of comorbid patients with hypertension, diabetes and coronary atherosclerosis

Abstract

Aim. To study the clinical effects and long-term outcomes of catheterbased renal denervation (CRD) in patients with cardiovascular disease and diabetes.Material and methods. This single-center prospective observational study included 60 patients with uncontrolled hypertension, type 2 diabetes, and coronary artery disease after complete endovascular revascularization. Patients were divided into 30 groups into the CRD group and the control group. CRD was performed via femoral access using a Spyral catheter (Medtronic, USA). The primary endpoint was the change in glycemic levels after 12 months.Results. In the CRD group, a significant decrease in basal glycemia level from 9,3 (7,67-10,12) to 6,05 (5,2-8,3) mmol/l, glycated hemoglobin from 7,6 (6,98,4) to 6,6 (6,2-7,2)%, Homeostasis Model Assessment Insulin Resistance (HOMA-IR) from 6,6 (3,73-11,2) to 4,76 (2,73-7,1) — in the absence of significant changes in the control group. A significant decrease in the average level of office systolic (-14 (-24; -10) mm Hg, p=0,0002) and diastolic blood pressure (-10 (-10; -6) mm Hg, p=0,0002), p=0,0007) was also revealed — in the absence of significant changes in the control group. There were no significant differences in late lumen loss between the groups: 21,8% (17,3-28,8) in the CRD group vs 26,3% (19,5-34,0) in the control group (p=0,09).Conclusion. A positive effect of CRD on carbohydrate metabolism in patients with type 2 diabetes, hypertension and coronary artery disease was revealed. The hypothesis of the pleiotropic effects of CRD was confirmed.

Keywords

• comorbidity
• diabetes
• insulin resistance
• hypertension
• coronary artery disease
• renal denervation
• radiofrequency ablation