As most of you probably know, a study came out a couple of years showing that renal sympathetic nerve denervation can dramatically lower blood pressure in a hypertensive patient. While the reno-centric scientists out there said "See! I TOLD you it was the kidney!", the evidence as a whole suggested that a more global phenomenon was occurring, since whole body norepinephrine spillover and sympathetic activity to the muscle were reduced in these patients. In addition to affecting blood pressure, symptahetic overactivity can negatively affect glucose metabolism. When beta adrenergic receptors in the liver are stimulated by cuirculating epinephrine, liver cells increase glucose production and subsequently plasma glucose and inculin levels increase. In turn, insulin stimulates sympathetic nerve activity, forming a cycle of activation. The authors guessed that glucose metabolism would benefit from renal denervation as well.
They performed the procedure in 37 patients with resistant hypertension and assigned 13 to the control group. A catheter was inserted into the renal artery and radiofrequency pulses were used ot heat the tip of the catheter and ablate the artery at various spots. This procedure kills any nerves running in and around the artery and causes a scar to form that prevents reinnervation. Blood pressure and markers of glucose metabolism were measured before and 1 and 3 months after the study.
The authors found that renal denervation had a marked effect on glucose metabolism. It is important to note that the patients' glucose and insulin levels were only slightly above normal before the study. fasting gluicose decreased, baseline insulin levels decreased, and blood pressure decreased as expected. Interestingly, some members in the trestment group were 'cured' of diabetes or pre-diabetes, depending on how you look at it. Now, does this prove that denervation blunts central sympathetic outflow to the adrenal gland and thus epinephrine secretion to cause these effects? No. Is it enough evidence to be suggestive? To me, yes. But then again, the appearance of the moon may suggest that it is made of cheese. In any case, this study reminds one to remember the BIG PICTURE. Sympathetic overactivity means much more than just blood pressure.
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-Nick
The authors found that renal denervation had a marked effect on glucose metabolism. I agree with you.So you have done a fantastic job by sharing this kind of important knowledge.
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