Endovascular denervation combined with renal sympathetic denervation for treating uncontrolled drug-treated hypertension with type 2 diabetes: A case report

Abstract

Uncontrolled drug-treated hypertension can lead to serious cardiovascular and cerebrovascular events. Type 2 diabetes mellitus has caused a huge health burden worldwide, with the global prevalence of chronic hyperglycemia or diabetes being approximately 1 in 11 among adults. Even in patients who are compliant with medication treatment and lifestyle changes, glycemic control may still be inadequate. In this case report, a young Chinese patient with uncontrolled drug-treated hypertension and type 2 diabetes was successfully treated with endovascular denervation combined with renal sympathetic denervation under three-dimensional guidance through the Ensite Velocity 5.0 system. The positive results from this study provide new opportunities for the treatment of uncontrolled drug-treated hypertension with type 2 diabetes.

Keywords

Uncontrolled drug-treated hypertension / Type 2 diabetes / Endovascular denervation / Renal sympathetic denervation / Three-dimensional modeling / Pressure ablation catheter

Acknowledgments

None.

Funding

This work was supported by the 940th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army (grant number 2021yxky080 to Ling Ma, grant number 2021yxky031 to Fei Wang), the Gansu Province Health Industry Plan Project (grant number GSWSKY2023-47 to Ling Ma), the Gansu Province Science and Technology Plan Project (grant number 22JR5RA013 to Fangju Su), the Lanzhou Youth Science and Technology Talent Innovation Project (grant number 2024-QN-41 to Juan Feng), and the Northwest University for Nationalities Central University Major Demand Cultivation Project (grant number 31920220109 to Fangju Su).

Conflict of interest

The authors declare they have no competing interests.

Author contributions

Conceptualization: Piqi Jiao

Investigation: Peng Zhang, Fei Wang, Piqi Jiao

Writing-original draft: Fangju Su, Juan Feng

Writing-review & editing: Ling Ma

Ethics approval and consent to participate

The ethics committee approved the study of the 940th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army. Written informed consent was obtained from the individual(s) for the publication of data included in this article.

Consent for publication

Written informed consent was obtained from the individual(s) for the publication of data included in this article.

Availability of data

Not applicable.

References

[1] Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/ AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/ PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American college of cardiology/ American Heart Association task force on clinical practice guidelines. Circulation. 2018; 138:e426-e483. doi: 10.1161/CIR.0000000000000597

[2] Blood Pressure Lowering Treatment Trialists Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: An individual participant-level data meta-analysis. Lancet. 2021; 397:1625-1636. doi: 10.1016/S0140-6736(21)00590-0

[3] Blood Pressure Lowering Treatment Trialists Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: An individual participant-level data meta-analysis. Lancet. 2021; 398:1053-1064. doi: 10.1016/S0140-6736(21)01921-8

[4] Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet. 2016; 387:957-967. doi: 10.1016/S0140-6736(15)01225-8

[5] Kario K, Hoshide S, Narita K, Okawara Y, Kanegae H, Investigators n. Cardiovascular prognosis in drug-resistant hypertension stratified by 24-hour ambulatory blood pressure: The JAMP study. Hypertension. 2021; 78:1781-190. doi: 10.1161/HYPERTENSIONAHA.121.18198

[6] Osborn JW, Tyshynsky R, Vulchanova L. Function of renal nerves in kidney physiology and pathophysiology. Annu Rev Physiol. 2021; 83:429-450. doi: 10.1146/annurev-physiol-031620-091656

[7] Schmieder RE. Renal denervation: Where do we stand and what is the relevance to the nephrologist? Nephrol Dial Transplant. 2022; 37:638-644. doi: 10.1093/ndt/gfaa237

[8] Bohm M, Kario K, Kandzari DE, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): A multicentre, randomised, sham-controlled trial. Lancet. 2020; 395:1444-1451. doi: 10.1016/S0140-6736(20)30554-7

[9] Mahfoud F, Kandzari DE, Kario K, et al. Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): A randomised, sham-controlled trial. Lancet. 2022; 399:1401-1410. doi: 10.1016/S0140-6736(22)00455-X

[10] Barbato E, Azizi M, Schmieder RE, et al. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC council on hypertension and the European association of percutaneous cardiovascular interventions (EAPCI). Eur Heart J. 2023; 44:1313-1330. doi: 10.1093/eurheartj/ehad054

[11] Pan T, Li L, Wei Q, et al. Endovascular celiac denervation for glycemic control in patients with type 2 diabetes mellitus. J Vasc Interv Radiol. 2021; 32:1519.e2-1528.e2. doi: 10.1016/j.jvir.2021.07.023

[12] Mobinizadeh M, Arabloo J, Hamouzadeh P, Akbari Sari A. A systematic review of the effectiveness of catheter ablation NavX mapping system for treatment of the cardiac arrhythmia. Med J Islam Repub Iran. 2015; 29:189.

[13] Khongphatthanayothin A, Kosar E, Nademanee K. Nonfluoroscopic three-dimensional mapping for arrhythmia ablation: Tool or toy? J Cardiovasc Electrophysiol. 2000; 11:239-243. doi: 10.1111/j.1540-8167.2000.tb01792.x

[14] Hindricks G, Weiner S, McElderry T, et al. Acute safety, effectiveness, and real-world clinical usage of ultra-high density mapping for ablation of cardiac arrhythmias: Results of the TRUE HD study. Europace. 2019; 21:655-661. doi: 10.1093/europace/euy191

[15] Kawakami T, Saito N, Yamamoto K, et al. Zero-fluoroscopy ablation for cardiac arrhythmias: A single-center experience in Japan. J Arrhythm. 2021; 37:1488-1496. doi: 10.1002/joa3.12644