Comparative assessment of the impact of renal denervation on blood pressure values in resistant hypertensive patients with and without type 2 diabetes

Abstract

Introduction. Randomized clinical trial data confirm the effectiveness of renal artery denervation (RDN) not only among hypertensive patients, but also in other pathologies associated with increased SNS activity, such as type 2 diabetes, heart failure and others. Aim. Evaluation of the impact of RDN on blood pressure values in two categories of patients - resistant hypertension with and without type 2 diabetes. Materials and methods. The randomized prospective clinical study was designed that enrolled 250 resistant hypertensive patients divided into two equal groups of 125 patients depending to the presence of DM. The patients in the first two subgroups of each group were given standardized treatment supplemented with SNS blockers Moxonidine and Bisorpolol , while patients from subgroups III and VI underwent RDN. Patients were evaluated by dynamic ambulatory BP monitoring for a period of 3 years. Results. Authentic reduction of office SBP and DBP was noted starting from 6 months of assessment in all research groups, the comparative analysis of dynamics of office SBP at all stages of evaluation demonstrating a clear superiority of groups of minimally invasive treatment by RDN versus pharmacological treatment with the SNS blockers Moxonidine and Bisoprolol in improving these parameters. At the same time, a statistically significant reduction in the average values of SBP and DBP 24 hours was recorded in both the pharmacological and interventional treatment groups independent ofthe presence of type 2 diabetes, the maximum antihypertensive effect being expressed at 36 months of evaluation. Diabetic and non-diabetic patient groups undergoing RDN demonstrated superiority to both pharmacotherapeutic regimens at all follow-up stages.Conclusions. The obtained results demonstrated the comparable antihypertensive efficacy of RDN in resistant hypertensive patients with or without type 2 diabetes. At the same time, the groups of diabetic and non-diabetic patients undergoing RDN showed superiority over both pharmacotherapeutic regimens with SNS blockers in reducing blood pressure values, the beneficial effect being maintained for a three-year follow-up period.