Predictive value of HOMAIR indices for severity of left ventricular diastolic dysfunction and NT-proBNP activity

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Academy of Sciences of Moldova

Hypertension (HT) and insulin resistance (IR) often coexist and condition LV diastolic function's alteration. Diastolic dysfunction (DD) identifies hypertensives with high cardiovascular risk independent of LV mass and BP level. NT-pro BNP level serve as a diagnostic and prognostic tools in patient with DD. Several studies suggest that DD severity could be interdependent with some biomarkers (HOMAIR, NT-proBNP).

Aim

To determine if HOMA IR indices could play a predictive role in appreciating severity of LV diastolic dysfunction/ NT-proBNP activity.

Methods

101 hypertensive patients (mean age 50.11±0.79 yrs; 48.51% of men, SBP/DBP: 201.31±7.41/106.25±5.54 mmHg, BMI- 29.38±0.22 kg/m2 ,  HOMA IR - 2.67±0.81) with DD and IR (HOMAIR > 2.5) were enrolled for the study. Ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography (TE), HOMAIR and NT-pro BNP were performed at baseline and after 6, 12- months period of treatment. DD patterns were appreciated according to ASE/EACVI 2016 guideline. NT-proBNP cut-off value was considered > 125 pg/ml (ESC). Correlation analysis was performed using Pearson’s test. The correlation coefficient was considered weak at <0.3, medium-0.3-0.7 and strong > 0.7-1.0. Statistical significance was appreciated at a P-value <0.05 and highly significant at a P-value <0.001.

Results

The baseline characteristics of bunch are shown in Fig 1. Diastolic dysfunction, HOMA-IR and NT-proBNP levels demonstrated a statistically significant correlation (p< 0.001). A more advanced patterns of diastolic dysfunction demonstrated a particularly strong relationship with higher HOMA-IR and NT-proBNP levels ( Tab. 1).

Conclusion

In hypertensives with increase in insulin resistance, progression of the left ventricle disorder could develop. The interrelation is in such manner, that the higher is HOMAIR level, the more advanced patterns of diastolic dysfunction and NT-pro BNP activity occure.

Sympathetic renal denervation treatment in resistant hypertension: one-year follow-up

Aims

A comparison influence of renal denervation versus pharmacological treatment with sympathetic nervous system blockers on blood pressure in patients with resistant hypertension.

Methods

125 patients with resistant hypertension without comorbidities after a 3-week standardized treatment with Losartan 100 mg, Amlodipine 10 mg and Indapamid 1,5 mg and confirmation of their resistance were randomly assigned into three groups, depending on medication supplemented to previously administered: IM group – selective I1-imidazoline agonist Moxonidine, IIB group – cardioselective beta-blocker Bisoprolol and IIID group – renal artery denervation. Patients were assessed by ambulatory blood pressure monitoring at baseline, 3, 6 and 12 month follow-up. The compliance to drug treatment was confirmed by 8-item Morisky Medication Adherence Scale. Renal denervation was performed with a Symplicity Spyral catheter.

Results

The mean 24 hour systolic blood pressure (SBP m/24 h) at baseline were 179.0±2.02 mmHg in IM group versus 177.96±2.44 mmHg in IIB group and 176.92±1.97 mmHg in IIID group, p>0.05. Statistically significant dynamics was recorded starting with 3 months of evaluation in all three groups, the group of patients undergoing denervation of the renal arteries demonstrating a net superior effect compared with pharmacological treatment: −6.48±0.81 mmHg in I M group versus −6.2±0.88 mmHg in II B group and −23.28±1.9 mmHg in III D group, p<0.001. The beneficial effect was maintained until the end of the study, when in observational group supplemented with Moxonidine SBP m/24 h were 159.6±1.72 mmHg with a total reduction of −19.9±0.7 mmHg from baseline, in Bisoprolol group −164.08±1.93 mmHg with a reduction of −13.88±1.13 mmHg and 141.76±0.77 mmHg in renal denervation group with a total reduction of −35.16±2.23 mmHg, p<0.001.

The mean 24 hour diastolic blood pressure (DBP m/24 h) increased at baseline in all three groups (105.52±1.28 mmHg in IM versus 108.6±1.6 mmHg in IIB and 107.24±0.92 mmHg in IIID, p>0.05) similar to SBP m/24 h noted a significantly reduction at 3 month follow-up: −4.8±0.96 mmHg in IM group versus −3.64±0.47 mmHg in IIB group and −12.08±0.63 mmHg in IIID group, p<0.001. The maximum reduction in DBP m/24 h were registered at 12 month follow-up, a comparative analyses of dynamics between groups showing a presence of statistical difference due to superiority of renal denervation treatment in amelioration of this parameter: −13.68±0.83 mmHg in IM group versus −10.72±0.64 mmHg in IIB group and −20.2±1.28 mmHg in IIID group, p<0.001.

Conclusions

The application of all three treatment regimens has been shown to be effective in reducing SBP and DBP values m/24 hours in patients with resistant hypertension, with a superior but comparable effect of Moxonidine to Bisoprolol and the absolute superiority of renal denervation treatment versus both pharmacological treatment regimens.

Funding Acknowledgement

Type of funding source: None