P5849Some possible mechanisms for the antihypertensive efficacy of renal sympathetic denervation in patients with resistant hypertension and type 2 diabetes mellitus

Background: Diabetic patients with resistant hypertension (RHT) are characterized by a sympathetic overactivity with the hyperstimulation of the renin-angiotensin-aldosterone system and sodium and volume retention. Renal sympathetic denervation (RD) is a non-pharmacological method of treatment of RHT. Purpose: The aim of this study was to evaluate the change in renin activity and aldosterone serum level, 24-hour urine volume and urinary sodium excretion in diabetic patients with RHT after renal denervation. Methods: Forty seven diabetic patients with true RHT were included in single-arm prospective interventional study (detailed protocol was published on ClinicalTrial.gov, number NCT01499810) (mean age 60.0±8.8 years, mean office blood pressure (BP) 169.7±19.17mmHg, mean HbA1c 6.7±1.4%, eGFR 76.4±21.9 mL/min/1.73m2, 18 men). RD was performed as bilateral transluminal radiofrequency ablation of neural pathways adjacent to renal artery. Office BP measurement, ambulatory 24-h BP monitoring (ABPM), renal Doppler ultrasound and measurement of renin activity, aldosterone serum level (enzyme immunoassay methods), volume of 24-hour urine, level of sodium in 24-hour urine were performed at baseline and 12, 24 months after RD. On average, patients were taking 4 (3–5) antihypertensive drugs. None of the patients changed the antihypertensive and antidiabetic treatments during follow-up. Twelve and 24 months follow up were completed by 38 and 15 patients, respectively.