Effects of renal denervation on insulin resistance

Abstract

Hypertension and diabetes are recognized as two major comorbidities accounting for the greatest proportion of cardiovascular morbidity and mortality. Despite the availability of safe and effective pharmacological therapies, the percentage of patients achieving optimal blood pressure and glycemic control remains unsatisfactory. The contribution of sympathetic activation to the development and maintenance of systemic hypertension and comorbidities is well recognized. Aside from several novel pharmacological approaches, catheter-based sympathetic renal denervation (RDN) has gained a significant role in treatment-resistant hypertension and has recently been introduced to clinical practice. Preliminary data indicate that aside from better blood pressure control, RDN may also be associated with a reduction in fasting glucose and insulin levels, as well as improvements in the Homeostasis Model Assessment (HOMA) index. If these observations are confirmed in larger controlled clinical trials, RDN may emerge as a preferred treatment option for patients with resistant hypertension and concomitant alterations of glucose metabolism.

Keywords::

• diabetes
• hypertension
• insulin resistance
• obesity
• renal denervation
• sympathetic activity

Financial & competing interests disclosure

The study discussed was funded in part by grants from the National Health and Research Council of Australia (NHMRC) and the Victorian Government’s Operational Infrastructure Support Program. D Hering has been awarded by a Research Fellowship from the Foundation for Polish Science KOLUMB/2010-1. MP Schlaich and MD Esler are supported by career fellowships from the NHMRC, are investigators in studies sponsored by Medtronic and have received honoraria for presentations and consulting, as well as travel support. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.