LEPTIN AS A PREDICTOR OF CARDIOPROTECTIVE EFFICIENCY OF RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Abstract

Objective: To evaluate serum leptin level before renal denervation (RDN) and to assess whether this baseline metabolic marker predicts cardioprotective efficacy in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM). Design and method: The study included 25 patients with RHTN and T2DM (mean age 60.9 ± 7.1 years, 16 women, mean 24-hour (24-h) blood pressure (BP) (systolic/diastolic) 158.8 ± 16.5/81.1 ± 13.1 mm Hg, mean HbA1c 7.4 ± 1.5%). All patients were enrolled in the prospective interventional study with RDN (NCT02667912 and NCT01499810 at ClinicalTrials.gov). Office BP and ABPM, tissue Doppler echocardiography with assessment of diastolic function, serum leptin level were performed at baseline and 6-months after RDN. Twenty patients completed a 6-month follow-up. Results: RDN led to a significant reduction in systolic and diastolic 24-h BP (-13.4/-7.6 mm Hg, p = 0.001/0.002). The baseline leptin level correlated with the mean E/e ‘ratio at baseline (R = 0.52, p = 0.015) and its dynamics after 6 months (R = 0.71, p = 0.001). Depending on the degree of decrease in average E/e’ ratio, the patients were retrospectively divided into 2 groups: 1st (with improvement) (persons with a decrease in average E/e’ ratio by 1 unit or more, n = 10 (50%)) and 2nd (without improvement) (with a lesser degree of decrease in average E/e’ ratio). Initially, the pts of 1st group not differed from those of 2nd group by age, BP and HbA1c level. At the same time, pts of the 1st group had higher baseline leptin level (60.4 ± 24.05 and 35.8 ± 9.82 ng/ml, p = 0.008) than pts of the 2nd group. A ROC analysis showed that the best cut-off value of the leptin level is 47.4 ng/ml with 70% sensitivity and 85% specificity (AUC: 0.84; 95% CI:0.64–1.04; p = 0.001). Conclusions: Estimation of the leptin allows predicting the cardioprotective efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus.