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Carnagarin R, Lambert GW, Kiuchi MG, Nolde JM, Matthews VB, Eikelis N, Lambert EA, Schlaich MP. Effects of sympathetic modulation in metabolic disease. Ann N Y Acad Sci 2019; 1454:80-89. [DOI: 10.1111/nyas.14217] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/07/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
| | - Gavin W. Lambert
- Iverson Health Innovation Research InstituteSwinburne University of Technology Hawthorn Victoria Australia
- School of Health SciencesSwinburne University of Technology Hawthorn Victoria Australia
| | - Marcio G. Kiuchi
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
| | - Janis M. Nolde
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
| | - Vance B. Matthews
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
| | - Nina Eikelis
- Iverson Health Innovation Research InstituteSwinburne University of Technology Hawthorn Victoria Australia
- School of Health SciencesSwinburne University of Technology Hawthorn Victoria Australia
| | - Elisabeth A. Lambert
- Iverson Health Innovation Research InstituteSwinburne University of Technology Hawthorn Victoria Australia
- School of Health SciencesSwinburne University of Technology Hawthorn Victoria Australia
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine – Royal Perth Hospital Unit/Medical Research FoundationUniversity of Western Australia Perth Western Australia Australia
- Departments of Cardiology and NephrologyRoyal Perth Hospital Perth Western Australia Australia
- Neurovascular Hypertension and Kidney Disease LaboratoryBaker Heart and Diabetes Institute Melbourne Victoria Australia
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Kampmann U, Mathiassen ON, Christensen KL, Buus NH, Bjerre M, Vase H, Møller N, Kaltoft A, Poulsen PL. Effects of Renal Denervation on Insulin Sensitivity and Inflammatory Markers in Nondiabetic Patients with Treatment-Resistant Hypertension. J Diabetes Res 2017; 2017:6915310. [PMID: 29082259 PMCID: PMC5610868 DOI: 10.1155/2017/6915310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/09/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022] Open
Abstract
Increased sympathetic activity is important in the pathogenesis of hypertension and insulin resistance. Afferent signaling from the kidneys elevates the central sympathetic drive. We investigated the effect of catheter-based renal sympathetic denervation (RDN) on glucose metabolism, inflammatory markers, and blood pressure in nondiabetic patients with treatment-resistant hypertension. Eight subjects were included in an open-labelled study. Each patient was studied before and 6 months after RDN. Endogenous glucose production was assessed by a 3-3H glucose tracer, insulin sensitivity was examined by hyperinsulinemic euglycemic clamp, hormones and inflammatory markers were analyzed, and blood pressure was measured by office blood pressure readings and 24-hour ambulatory blood pressure monitoring. Insulin sensitivity (M-value) increased nonsignificantly from 2.68 ± 0.28 to 3.07 ± 0.41 (p = 0.12). A significant inverse correlation between the increase in M-value and BMI 6 months after RDN (p = 0.03) was found, suggesting beneficial effects on leaner subjects. Blood pressure decreased significantly, but there were no changes in hormones, inflammatory markers, or endogenous glucose production. Our results indicate that RDN may improve insulin sensitivity in some patients with treatment-resistant hypertension, albeit confirmation of these indications of beneficial effects on leaner subjects awaits the outcome of larger randomized controlled studies.
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Affiliation(s)
- Ulla Kampmann
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Ole N. Mathiassen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Kent L. Christensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Niels H. Buus
- Department of Nephrology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Mette Bjerre
- Medical Research Laboratory, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Niels Møller
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
- Medical Research Laboratory, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Anne Kaltoft
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Per L. Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
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Baroni M, Nava S, Giupponi L, Meani P, Panzeri F, Varrenti M, Maloberti A, Soriano F, Agrati AM, Ferraro G, Colombo F, Rampoldi A, Mancia G, Colombo P, Klugmann S, Giannattasio C. Effects of Renal Sympathetic Denervation on Arterial Stiffness and Blood Pressure Control in Resistant Hypertensive Patients: A Single Centre Prospective Study. High Blood Press Cardiovasc Prev 2015; 22:411-6. [PMID: 26458940 DOI: 10.1007/s40292-015-0121-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/01/2015] [Indexed: 12/29/2022] Open
Abstract
Renal denervation (RD) is an intriguing treatment strategy for resistant hypertension. However, limited data are available about its long time efficacy as well as its effects on intermediate phenotypes like arterial stiffness and carotid IMT. 12 patients (9 males, mean 69 years) with resistant hypertension underwent bilateral RDN (Medtronic System) since April 2012 in Niguarda Ca' Granda Hospital (Milan). Patients were studied before intervention, and at 1, 3, 6 and 12 months after RD. Carotid intima media thickness (Esaote Mylab) and carotid-femoral pulse wave velocity (Complior, Alam medical) were assessed at each step. Compared to baseline, patients showed a marked reduction of office systolic blood pressure at each follow-up step (p < 0.05 versus baseline for all steps) as well as pulse wave velocity (p < 0.01 at 1 year versus baseline). Moreover, reduction in pulse wave velocity was higher than the expected value obtained only considering blood pressure drop. Conversely, no significant effect was observed on diastolic blood pressure as well as carotid intima-media thickness. In our study, renal denervation was a safe and effective procedure. The BP lowering effect was maintained during follow-up and a beneficial effect on arterial stiffness was observed, which implies that this effect can't passively originate from the BP fall but rather from an improvement of arterial mechanical properties, possibly related to a reduced sympathetic arterial drive.
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Affiliation(s)
- Matteo Baroni
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy. .,Health Science Department, Milan-Bicocca University, Milan, Italy.
| | - Stefano Nava
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Luca Giupponi
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Paolo Meani
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Francesco Panzeri
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Marisa Varrenti
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Alessandro Maloberti
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Francesco Soriano
- Cardiology I, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Giovanni Ferraro
- Internal Medicine Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Fabrizio Colombo
- Internal Medicine Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Antonio Rampoldi
- Interventional Radiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Giuseppe Mancia
- Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Paola Colombo
- Cardiology I, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Silvio Klugmann
- Cardiology I, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Cristina Giannattasio
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
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