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[PP.15.41] RENAL HEMODYNAMICS AFTER RENAL DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Objective: Both the type 2 diabetes mellitus (T2DM) and resistant hypertension (RHTN) are associated with increased of renal sympathetic nerve activity and reduction renal blood flow. The aim of this study was to evaluate effect of renal denervation (RDN) on renal hemodynamics in patients with RHTN and T2DM. Design and method: Forty seven patients with true RHTN and T2DM (mean age 60.0 ± 8.8 years, mean office blood pressure (BP) 169.7 ± 19.1 mmHg, eGRF 74.4 ± 21.7 mL/min/1.73m2 (according to MDRD formula), mean HbA1c 6.7 ± 1.4%, 18 male) were included in single-arm prospective interventional study (detailed protocol was published on ClinicalTrial.gov, number NCT01499810). Office BP measurement, ambulatory 24-hour BP, renal Doppler ultrasound (with measured of renal resistive index (RRI)) and assessment of renal function, HbA1c levels were performed at baseline and follow up. On average, patients were taking 4 (3–5) antihypertensive drugs at optimal dosages, including a diuretic. None of the patients changed the antihypertensive treatments during follow-up. Twelve months follow up was completed by 38 pts. Results: RDN reduced both office BP and 24h-BP at 12 months by 25.4/12.5 mmHg and 12.4/6.9 mmHg, p < 0.01 respectively. The mean values of RRI were no change after RDN. There were increasing RRI in 19% pts, no change in 47% pts and decreasing in 34% pts after 12 months. Decrease in RRI in trunks after 12 months was significantly correlated with decrease both in 24h-diastolic BP (DBP) and night-DBP (r = 0.41, p = 0.03 and r = 0.43, p = 0.03, respectively), as well as with reduction in load of 24h-DBP and night-DBP (r = 0.41, p = 0.04 and r = 0.39, p = 0.04, respectively). Reduction of RRI in segmental arteries was associated with increase in heart rate standard deviation (HRSD) (r = −0.48, p = 0.01 for 24h-HRSD and r = −0.47, h = 0/015 for night-HRSD). Conclusions: Mean values of renal resistive index were not changed within one year after renal denervation in patients with RHTN and T2DM; however, increases in HRSD, reflecting positive effect on the autonomic nervous system, and decreases in diastolic BP were associated with improvement of renal hemodynamics.