The effect of renal denervation in microcirculation: focusing on coronary microvascular dysfunction

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Biology

Background:

• Arterial hypertension is a leading global cardiovascular pathology with high rates of uncontrolled cases and treatment non-adherence.
• Renal denervation is now recognized as a key treatment modality for hypertension, addressing sympathetic overactivation.
• Sympathetic overactivation contributes to hypertension and other cardiovascular diseases, making renal denervation a potential therapeutic target beyond hypertension.

Purpose of the Study:

• To review the pathophysiological links between microvascular dysfunction and hypertension.
• To examine the impact of renal denervation on hypertension-mediated target organ damage.
• To analyze preclinical and clinical data on renal denervation's efficacy and safety in improving coronary microcirculation.

Main Methods:

• Literature review of preclinical and clinical studies.
• Analysis of pathophysiological mechanisms.
• Evaluation of interventional data in coronary microvascular dysfunction.

Main Results:

• Preclinical data suggest renal denervation enhances microcirculatory homeostasis, improves endothelial vasodilation, and reduces inflammation.
• Clinical studies on coronary microvascular dysfunction have reported neutral effects, indicating a gap between preclinical findings and clinical outcomes.
• Limited non-interventional studies in coronary microcirculation have shown no significant benefit.

Conclusions:

• Renal denervation's role in managing hypertension and its target organ damage is established.
• Translating preclinical benefits of renal denervation to clinical improvements in coronary microvascular dysfunction remains a challenge.
• Further research is needed to explore future directions for renal denervation in microcirculatory health.