Renal Denervation May Slow the Progression of Subclinical Brain Damage in Diabetic Patients With Resistant Hypertension During 3 Years Follow-Up

Abstract

Objective: Patients with resistant hypertension and type 2 diabetes mellitus (DM) accelerate the subclinical brain damage and the age-related brain atrophy, which leads to a more rapid decrease in cognitive functions. Brain MRI can detect expansion of liquor spaces and white matter lesions (PWMLs), which are patterns of brain atrophy. Renal denervation (RDN) is an effective treatment for resistant hypertension (RHTN), but the key question is whether RDN can slow the progression of brain damage. The aim of this study was to evaluate the effect of renal denervation on the MRI- sing of brain damage in patients with RHTN with type 2 DM over a 3-year follow-up. Design and method: The study included 17 diabetic patients with RHTN (mean age 61,3 ± 6.2 years; 9 males, mean 24 hour (systolic/diastolic) blood pressure (BP) 161.3 ± 19.4/82.2 ± 13.5 mmHg, HbA1c 7 ± 1,2%) from single-arm prospective interventional study (NCT02667912 on ClinicalTrial.gov) in whom 1.5T magnetic resonance imaging (MRI) of the brain and 24-hour BP monitoring were performed at baseline and an annually for 3 years follow up. We measured linear dimensions of liquor spaces (subarachnoidal spaces (SAS), lateral ventricles (LV), both III and IV ventricles) and calculated the number of focal white matter lesions. Periventricular white matter lesions (PWMLs) were evaluated semi-quantitatively on a scale of 0 to 4. On average, patients were taking 4.3 ± 1.0 antihypertensive drugs and were instructed not to change their medication regimen for the duration on the study. The mean number of ablations was 13 ± 1.8 (10–16). Results: Three years after RDN, there was a significant decrease in the average 24-hour systolic/diastolic BP by 14.1/8.6 mm Hg (p = 0.03/0.04). The linear dimensions of liquor spaces (SAS, LV, both III and IV ventricles), number of focal white matter lesions, as well as the mean PWMLs score did not change (p > 0.05). Conclusions: This is the first study to demonstrate that RDN can prevent progression of brain damage in diabetic patients with RHTN during 3 years follow-up and therefore has a potentially beneficial effect on the brain.