Available clinical evidence regarding the effect of renal denervation on glycemic control is conflicting, with a recent meta-analysis showing no significant difference in fasting glucose, insulin, or HbA1c levels.
Does renal denervation improve glycemic control in patients with hypertension and metabolic disorders?
While renal denervation aims to reduce sympathetic overactivation and shows promise in preclinical models for improving glucose homeostasis, clinical trial results remain conflicting regarding its metabolic benefits.
Renal Denervation (RDN) is an interventional, endovascular procedure used for the management of hypertension. The procedure itself aims to ablate the renal sympathetic nerves and to interrupt the renal sympathetic nervous system overactivation, thus decreasing blood pressure (BP) levels and total sympathetic drive in the body. Recent favorable evidence for RDN resulted in the procedure being included in the recent European Guidelines for the management of Hypertension, while RDN is considered the third pillar, along with pharmacotherapy, for managing hypertension. Sympathetic overactivation, however, is associated with numerous other pathologies, including diabetes, metabolic syndrome and glycemic control, which are linked to adverse cardiovascular health and outcomes. Therefore, RDN, via ameliorating sympathetic response, could be also proven beneficial for maintaining an euglycemic status in patients with cardiovascular disease, alongside its BP-lowering effects. Several studies have aimed, over the years, to provide evidence regarding the pathophysiological effects of RDN in glucose homeostasis as well as investigate the potential clinical benefits of the procedure in glucose and insulin homeostasis. The purpose of this review is, thus, to analyze the pathophysiological links between the autonomous nervous system and glycemic control, as well as provide an overview of the available preclinical and clinical data regarding the effect of RDN in glycemic control.
Koutra et al. (Fri,) conducted a review in Hypertension and metabolic pathologies. Renal Denervation (RDN) vs. Sham or pharmacotherapy was evaluated on Glycemic control parameters (fasting glucose, insulin, HbA1c, HOMA-IR). Available clinical evidence regarding the effect of renal denervation on glycemic control is conflicting, with a recent meta-analysis showing no significant difference in fasting glucose, insulin, or HbA1c levels.