Predictors of antihypertensive efficiency of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus

Abstract

Abstract Background Currently, one of the actively studied interventional methods for the treatment of resistant hypertension (RHTN) is renal denervation (RDN). Despite the safety of the procedure and the long-lasting antihypertensive effect, a significant decrease in systolic blood pressure (SBP) ≥10 mmHg is observed only in 60–80% of patients. According to the Global SYMPLICITY Registry (GSR) study, patients with diabetes mellitus could benefit from lower blood pressure after renal denervation due to initially higher sympathetic activity. The indicators associated with the processes of sympathetic hyperactivation include impaired diastolic function and total peripheral resistance (TPR), reflecting the resistance of arterioles (resistive vessels) to blood flow. Purpose To identify predictors of the antihypertensive efficacy of renal denervation in patients with RHTN and type 2 diabetes mellitus (DM) based on the results of a six-month follow-up. Methods The study included 36 patients with RHTN and type 2 diabetes mellitus (DM) (mean age 61,4±6,4 years, 14 men, mean 24-hour (24-hr) blood pressure (BP) (systolic/diastolic) 158,6±15,2/79,8±12,7 mmHg, mean HbA1c 7,2±1,2%). The prospective interventional study with renal denervation (NCT02667912 and NCT01499810 at ClinicalTrial.gov) enrolled 30 patients. Office BP and ABPM, diastolic function and TPR assessment were performed in all patients at baseline and 6 months after RDN. 29 patients completed 6-month follow-up. Results RDN led to a significant reduction in systolic and diastolic 24-hr BP (−10.9/−5.7 mmHg, p=0.002/0.003). Depending on the degree of decrease in 24-hr systolic BP, the patients were retrospectively divided into 2 groups: “responders” (persons with a decrease in 24-hr SBP by 10 or more mmHg) and “non-responders” (with a lesser degree of decrease in 24-hr SBP). The proportion of respondents to the intervention was 48.3%. Initially, the group of “responders” differed from the group of “non-responders” by higher average E/e' values (15.1 and 11.9, respectively, p=0.049) and TPR indicators (2.39±0.45 and 1.93±0.35 dyn s cm–5, respectively, p=0.003). These indicators were included in a logistic model to predict the antihypertensive efficacy of renal denervation. The sensitivity was 78.6% (11 correct predictions out of 14 cases), specificity – 80% (12 correct predictions out of 15 cases), (p=0.020). Conclusion Estimation of the total peripheral resistance and the average ratio E/e' allows predicting the antihypertensive efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research