Page 90 - BH-3-3

Brain & Heart Combination of EDN and RDN treatment

Pan et al. first introduced the concept and preliminary and has no history of diabetes. Physical examination on
11
clinical research results of endovascular denervation admission: body temperature of 36.2°C, respiration at
(EDN) in the treatment of type 2 diabetes. Innovatively, 21 times/min, heart rate at 102 beats/min, blood pressure
the radiofrequency ablation site was transferred from at 220/110 mmHg, weight is 86 kg, and height is 178 cm
the renal artery to the celiac artery, targeting the nerves (body mass index = 27.1). There were no symptoms
innervating the liver, pancreas, and gastrointestinal tract. and no physical signs in the heart, lungs, and abdomen.
Sympathetic nerves in internal organs, such as the liver, Laboratory tests showed 2-h postprandial blood glucose
directly affect the function of metabolic organs. Therefore, level oral glucose tolerance test at 16.0 mmol/L; the glycated
the results showed that EDN significantly improved blood hemoglobin measurement at 11.0%; aldosterone levels
sugar and insulin resistance, reduced drug dosage, and were 0.269 nmol/L (range: 0.165 – 0.482 nmol/L); and
improved the function of pancreatic beta cell function cortisol levels were 594 nmol/L (range: 111 – 552 nmol/L).
and liver. Cardiac color ultrasound showed left ventricular
This case report details the first patient in China hypertrophy (interventricular septum 11 mm). Adrenal
successfully treated for uncontrolled drug-treated thin-section computed tomography (CT) scan showed
hypertension with type 2 diabetes using EDN combined no abnormalities. Renal artery CT angiography (CTA)
with RDN under three-dimensional guidance on Ensite scan showed no obvious abnormalities (Figure 1). Oral
Velocity 5.0 system. The case report has been made in line administration of the antihypertensive medicines was
with the SCARE criteria. continued after admission (Table 1). The 24-h ambulatory
blood pressure after 1 week of treatment was maintained
2. Case presentation at 170/100 mmHg (Table 1). After admission, the patient’s
fasting blood sugar was 8.8 – 13.4 mmol/L, and his 2-h
The patient, a 44-year-old male, was admitted to the postprandial blood sugar was 13.3 – 20.9 mmol/L. The
hospital on May 15, 2023, because he “had elevated blood 24-h sleep monitoring showed no apnea. Combining all
pressure for 5 years and worsened with dizziness for laboratory and examination results, secondary causes of
1 month.” The patient went to a community hospital for hypertension were excluded, and the clinical diagnosis
dizziness 5 years ago and found that his blood pressure was was uncontrolled drug-treated hypertension and type 2
elevated. The measured blood pressure was 220/139 mmHg diabetes. After detailed communication with the patient
(1 mmHg = 0.133 kPa; the cuff was positioned on the and his family, it was decided that EDN combined with
patient’s upper arm at the level of the heart with the lower RDN would be performed. Written informed consent was
edge of the cuff a few centimeters above the antecubital provided by the patient before the operation.
fossa). He took multiple antihypertensive medicines
regularly for a long time (Table 1). Blood pressure readings For pre-operative preparation, the patient orally
fluctuated in the range of 180 – 190 mmHg for systolic took clopidogrel bisulfate tablets (300 mg) and aspirin
pressure and 100 – 110 mmHg for diastolic pressure. He enteric-coated tablets (300 mg) 1 day before surgery.
also has a history of type 2 diabetes for more than 7 years The operation procedure included skin adhesion using
and has been taking metformin hydrochloride tablets EN0020-P Surface Electrode Kit (Abbott, USA). After
(0.5 g ter in die) orally for hypoglycemic treatment. He has tracheal intubation, fentanyl (Renfu Medicine, China)
a smoking history of more than 5 years, with an average (100 µg/h) was continuously pumped intravenously, and
of 10 cigarettes/day. His father suffers from hypertension heparin (Shenzhen Sciprogen Biopharmaceutical, China)

Table 1. Oral medication adjustments

Medication Pre‑operative 1 week after 1 month after 3 months after 6 months – 1 year
surgery surgery surgery after surgery
Antihypertensive drugs
Irbesartan hydrochlorothiazide tablets (0.15 g) Bid qd qd qd qd
Nifedipine controlled-release tablets (30 mg) Bid qd qd qd qd
Metoprolol succinate tablets (47.5 mg) Qd qd qd Withdrawal Withdrawal
Terazosin hydrochloride capsules (2 mg) bid qd Withdrawal Withdrawal Withdrawal
Hypoglycemic agents
Metformin hydrochloride tablets (0.5 g) tid tid tid tid tid
Abbreviations: bid: Bis in die; qd: Quaque die; tid: Ter in die.

Volume 3 Issue 3 (2025) 2 doi: 10.36922/bh.5123