Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Cardiovascular Research Group, Institute of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
Gastrosurgery Research Group, UiT, The Arctic University of Norway, Norway.
Clin Nutr. 2021 Apr;40(4):1503-1509. doi: 10.1016/j.clnu.2021.02.027. Epub 2021 Mar 2.
BACKGROUND & AIMS: Denervation of renal sympathetic nerves (RDN) is an invasive endovascular procedure introduced as an antihypertensive treatment with a potential beneficial effect on insulin resistance (IR). We have previously demonstrated a reduction in blood pressure (BP) six months after RDN, but severe hepatic and peripheral IR, assessed by glucose tracer and two step hyperinsulinemic-euglycemic clamp (HEC), did not improve. The aim of the current study was to evaluate IR and adipokines profiles in relation to BP and arterial stiffness changes two years after RDN.
In 20 non-diabetic patients with true treatment-resistant hypertension, ambulatory and office BP were measured after witnessed intake of medications prior to, six and 24 months after RDN. Arterial stiffness index (AASI) was calculated from ambulatory BP. Insulin sensitivity (IS) was assessed using an oral glucose tolerance test (OGTT), the Homeostasis Model Assessment (HOMA-IR), HOMA-Adiponectin Model Assessment (HOMA-AD), the Quantitative Insulin Sensitivity Check Index (QUICKI), the Triglyceride and Glucose Index (TyG) and the Leptin-to-Adiponectin Ratio (LAR). These surrogate indices of IS were compared with tracer/HEC measurements to identify which best correlated in this group of patients.
All measured metabolic variables and IS surrogate indices remained essentially unchanged two years after RDN apart from a significant increase in HOMA-AD. OGTT peak at 30 min correlated best with reduction in endogenous glucose release (EGR) during low insulin HEC (r = -0.6, p = 0.01), whereas HOMA-IR correlated best with whole-body glucose disposal (WGD) (r = -0.6, p = 0.01) and glucose infusion rate (r = -0.6, p = 0.01) during high insulin HEC. BP response was unrelated to IS prior to RDN. Nocturnal systolic BP and arterial stiffness before RDN correlated positively with a progression in hepatic IR at six-month follow-up.
IR, adiponectin and leptin did not improve two years after RDN. There was no correlation between baseline IS and BP response. Our study does not support the notion of a beneficial metabolic effect of RDN in patients with treatment resistant hypertension.
肾去交感神经术（RDN）是一种侵入性的血管内操作，作为一种降压治疗方法引入，具有改善胰岛素抵抗（IR）的潜在益处。我们之前已经证明，RDN 后 6 个月血压（BP）降低，但严重的肝和外周 IR，通过葡萄糖示踪剂和两步高胰岛素-正常血糖钳夹（HEC）评估，并没有改善。本研究的目的是评估 RDN 两年后与血压和动脉僵硬变化相关的 IR 和脂肪因子谱。
在 20 名非糖尿病、真正的治疗抵抗性高血压患者中，在 RDN 前、6 个月和 24 个月时，在有见证的药物摄入后测量动态和诊室 BP。从动态 BP 计算动脉僵硬指数（AASI）。使用口服葡萄糖耐量试验（OGTT）评估胰岛素敏感性（IS），使用稳态模型评估（HOMA-IR）、HOMA-脂联素模型评估（HOMA-AD）、定量胰岛素敏感性检查指数（QUICKI）、甘油三酯和葡萄糖指数（TyG）和瘦素与脂联素比值（LAR）。这些 IS 的替代指标与示踪剂/HEC 测量进行比较，以确定在这组患者中哪些指标相关性最好。
除 HOMA-AD 显著增加外，RDN 两年后所有代谢变量和 IS 替代指标基本保持不变。OGTT 30 分钟峰值与低胰岛素 HEC 期间内源性葡萄糖释放（EGR）减少相关性最好（r=-0.6，p=0.01），而 HOMA-IR 与全身葡萄糖处置（WGD）相关性最好（r=-0.6，p=0.01）和高胰岛素 HEC 期间葡萄糖输注率（r=-0.6，p=0.01）。RDN 前 BP 反应与 IS 无关。RDN 前夜间收缩压和动脉僵硬与 6 个月随访时肝 IR 的进展呈正相关。
RDN 两年后，IR、脂联素和瘦素没有改善。IS 基线与 BP 反应之间没有相关性。我们的研究不支持 RDN 在治疗抵抗性高血压患者中有有益代谢作用的观点。
