PP.40.10

Abstract

Objective: to evaluate the factors effecting the blood pressure (BP) reduction and glycemic control improvement of patients with resistant hypertension (RH) with type 2 diabetes mellitus (T2DM). Design and method: Thirty two true resistant hypertensive patients with T2DM were included in single-arm prospective interventional study (detailed protocol was published on ClinicalTrial.gov, number NCT01499810). TRD was performed as bilateral transluminal radiofrequency ablation of neural pathways adjacent to renal artery. Office BP measurement, ambulatory 24-h BP monitoring (ABPM), renal Doppler ultrasound and assessment of renal function (proteinuria, creatinine, eGFR, volume of 24-hour urine, levels of K, Na in 24-hour urine), plasma HbA1c levels, basal glycaemia levels, levels of epinephrine in 24-h urine, plasma aldosterone levels and plasma renin activity levels were performed at baseline and 6 months after TRD. On average, patients were taking 4 (3–5) antihypertensive drugs. None of the patients changed the antihypertensive and antidiabetic treatments during follow-up. A 6 months follow-up was completed by 27 patients (43–75 years old, mean aged 59.3 ± 7.9 years, 14 male). Results: A significant reduction of average systolic office and 24-hour BP (from 173.7 ± 20.8 to 149.9 ± 19.4mmHg, p < 0.001 and from 160.8 ± 18.4 to 147.9 ± 16.9mmHg, p < 0.01, respectively) without any negative effect on renal function. Eighteen patients (67%) were responders with an SBP reduction > 10mmHg according to office measurement and 15 pts (56%) were responders according to ABPM. Six months later after RD 8 patients (30%) had the goal office SBP (p = 0.07), although 1 patient kept SBP>180mmHg. Also, there was observed significant reduction of mean HbA1c level after a 6-month follow-up (from 6.9 ± 1.8% to 5.8 ± 1.5%, p = 0.04). Both dynamics 24-hour SBP and HbA1c levels had inverse relationship to dynamics of 24-hour natriuresis (r = -0.69, p = 0.006 and r = -0.86, p = 0.01). Other relationships were not found. Conclusions: BP reduction and glycemic control improvement after the renal denervation of patients with resistant hypertension and diabetes mellitus were associated with growth of natriuresis, which reflects evidence of sympathetic tonus decrease and renal denervation effectiveness. Moreover, our data confirm that antihypertensive action of RD of these patients is implemented for the most part via natriuresis stimulation.