RENAL DENERVATION IMPROVES NOVEL BIOMARKERS OF INFLAMMATION, ATHEROGENESIS AND METABOLIC DISTURBENCES IN PATIENTS WITH UNCONTROLLED HYPERTENSION

Objective: This study evaluates the long-term effects of renal denervation (RDN) on novel biomarkers of inflammation and atherogenesis in patients with uncontrolled hypertension. Design and method: Out of 101 included in the Croatian RDN registry, in this longitudinal study, we included 27 patients (74% men, mean age 51.85 years) with a follow-up period longer than 18 months. Based on ambulatory blood pressure measurements (ABPM), patients were categorized as responders (defined as a 24-hour systolic blood pressure drop >10 mmHg) (N=16) and non-responders (N=11). RDN was performed with the Medtronic Symplicity Spiral system. The average follow-up period was 33.37 months. At baseline and every three months during the follow-up period office and ABPM were measured, as well as pulse wave velocity (PWV). Laboratory tests included complete blood cell count, serum creatinine, estimated glomerular filtration (eGFR), electrolytes, fasting blood glucose, HbA1c, cholesterol, LDL, HDL, and triglycerides. In addition, we analyzed novel biomarkers of inflammation and atherogenesis (neutrophils/lymphocytes, neutrophils/HDL, monocytes/HDL). Results: A significant decrease from baseline to the end of follow-up was observed for the neutrophils/ lymphocytes ratio in responders (2.95 to 2.30; p = 0.027) with a non-significant decrease in non-responders (2.71 to 2.55; p>0.05). The monocytes/HDL ratio decreased more in responders than in non-responders (0.55 to 0.02; 0.60 to 0.02, respectively, p = 0.002 for both). The neutrophils/HDL ratio decreased more in responders compared to non-responders (0.113 to 0.107; p = 0.001; 0.13 to 0.12; p = 0.004, respectively). Conclusions: In patients with uncontrolled hypertension, renal denervation improved novel biomarkers of inflammation and atherogenesis in all patients with a higher effect in those with better blood pressure control. These findings warrant further research to identify whether novel biomarkers of inflammation, atherogenesis and metabolic disturbances could be useful for the prediction of treatment outcomes.