MRI study of cerebroprotective effects of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus

Abstract

Objective. To assess the changes in subclinical MRI signs of brain damage in relationship with the changes in blood pressure, proinflammatory cytokines, and endothelial function one year after renal denervation (RDN) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (T2DM).Material and Methods. The prospective interventional study (ClinicalTrials.gov identifiers NCT02667912 and NCT01499810) analyzed qualitative brain MRI imaging data from 39 patients with RHTN and T2DM. All patients underwent 24-h ambulatory blood pressure monitoring (ABPM), brain MRI scan (1.5 T), blood tests for high-sensitivity C-reactive protein (hsCRP), and brachial artery flow-mediated dilation (FMD) measurements by high-resolution ultrasound. Patients were taking an average of 4.5 (3–6) antihypertensive drugs and were instructed not to change the therapy regimen throughout the study. A total of 29 patients completed the one-year follow-up.Results. A significant decrease in average daily systolic/diastolic blood pressure by 12 [95% CI 4.1; 19.8]/5.9 [95% CI 0.4; 11.3] mmHg (p = 0.004/0.038) according to 24-h ABPM, increase in FMD (p = 0.008), and a decrease in hsCRP level (p = 0.04) were observed one year after RHTN. Over half of patients (57%) had a decrease in 24-h systolic blood pressure by ≥ 10 mm Hg; target level of blood pressure was achieved in 38% patients. No changes in the MRI signs of brain damage (linear dimensions of liquor systems, white matter lesions [WMLs], brain damage MRI score, and intensity of MRI signal from the basal nuclei and WMLs) were observed except for a decrease in the severity of liquorodynamic disturbances. Reduction or stabilization of WML degree was observed in 24 patients (86%). No relationships were found between the dynamics of WMLs and the changes in blood pressure, FMD, and hsCRP.Conclusion. Administration of RDN to patients with RHTN and T2DM allowed to limit the WMLs in most cases and reduce the severity of liquorodynamic disorders during one-year of follow up.