SYSTEMIC VASCULAR RESISTANCE AS A PREDICTOR OF ANTIHYPERTENSIVE EFFICIENCY OF RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Abstract

Objective: To identify predictors of the antihypertensive efficacy of renal denervation (RDN) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM) based on the results of a 12-month follow-up. Design and method: The study included 56 patients with RHTN and T2DM (mean age 60.1 ± 7.9 years, 32 women, mean 24-hour (24-h) blood pressure (BP) (systolic/diastolic) 156.8 ± 15.2/82.2 ± 12.1 mm Hg, mean HbA1c 7.2 ± 1.5%). The prospective interventional study with RDN (NCT02667912 and NCT01499810 at ClinicalTrials.gov) enrolled all patients. Office BP and ABPM, calculation of systemic vascular resistance (SVR) assessment were performed at baseline and 12-months after RDN. Forty-one patients completed a 12-month follow-up. Results: RDN led to a significant reduction in systolic and diastolic 24-h BP (-10.6/-6.4 mm Hg, p = <0.001/<0.001). Depending on the degree of decrease in 24-h systolic BP, the patients were retrospectively divided into 2 groups: “responders’’ (persons with a decrease in 24-h SBP by 10 or more mmHg) and “non-responders’’ (with a lesser degree of decrease in 24-h SBP). The proportion of respondents to the intervention was 68.3%. Initially, the group of “responders’’ not differed from the group of “non-responders’’ by age, BP and HbA1c level. At the same time, responders had higher SVR indicators (2.22 ± 0.44 and 1.73 ± 0.28 dyn × s × cm-5, p = 0.001) than non-responders. A ROC analysis showed that the best cut-off value of the SVR is 19,7 dyn × s × cm-5 with 71% sensitivity and 85% specificity (AUC: 0.82; 95% CI: 0.68–0.95; p < 0.001). Conclusions: Estimation of the systemic vascular resistance allows predicting the antihypertensive efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus after a year of intervention.