Abstract
See related article, pp 559–565 “Effects of renal sympathetic denervation on blood pressure, sleep apnea course and glycemic control in patients with resistant hypertension and sleep apnea” by Witkowski et al is an illuminating report.1 The authors confirm that renal denervation lowers blood pressure (BP) in patients with stage 2 (BP ≥160/≥100 mm Hg) treatment-resistant hypertension adherent to optimal doses of ≥3 antihypertensive medications, including a diuretic.2,3 Their report also endorses the work of Mahfoud et al4 documenting that renal denervation in humans improves indices of insulin action and glucose metabolism. It should be noted, however, that glycosylated hemoglobin levels declined significantly among patients in the current but not the previous report.1,4 The current publication extends previous work by documenting that the BP and metabolic benefits of renal denervation include patients with sleep apnea. However, this is not surprising, because most hypertensive patients with treatment-resistant hypertension have sleep apnea,1 and it is unlikely that renal denervation would have been effective in previous studies if benefits did not extend to patients with sleep apnea. The novel aspect of the current work is that renal sympathetic denervation improved sleep apnea in 7 of 8 patients with obstructive sleep apnea and 1 of 2 patients with both obstructive and central components. Although the mechanism(s) by which renal denervation may improve obstructive sleep apnea is unknown, the authors' hypothesis that changes in sodium-volume status are …
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