Renal Denervation Improves Hepatic Steatosis in Hypertensive Patients With Metabolic Syndrome

Sympathetic overactivity is associated with hepatic steatosis. Renal denervation (RDN) is an approved treatment for uncontrolled hypertension through sympathetic modulation; however, its hepatic effects are unknown. This study aimed to assess the effects of RDN on noninvasive tests for hepatic steatosis.

This single-center study included patients with uncontrolled hypertension and cardiometabolic comorbidities undergoing RDN (n=32) or a sham procedure (n=10). Noninvasive tests for hepatic steatosis, including the hepatic steatosis index (HSI) and fatty liver index (FLI), were calculated at baseline and follow-up visits. An external cohort from the UK Biobank was used to validate the correlation between proton density fat fraction magnetic resonance imaging scans of the liver and these surrogates.

Compared with the control group, RDN significantly reduced HSI at 3 months (0.4±0.5 versus -1.3±0.3; P=0.009), 6 months (0.0±0.9 versus -2.6±0.5; P=0.027), and 12 months (0.0±0.6 versus -2.1±0.5; P=0.013), as well as FLI at 3 months (2.6±2.2 versus -3.8±1.2; P=0.021), 6 months (4.1±2.4 versus -5.7±1.2; P=0.002), and 12 months (2.0±2.7 versus -6.2±1.3; P=0.018). No significant differences were found in HSI (-1.9±0.7 versus -2.2±0.7; P=0.77) and FLI (-7.1±1.8 versus -5.3±1.7; P=0.49) between subjects in the intervention group whose office blood pressure decreased above or below the median of 19.5 mm Hg after 12 months. In the UK Biobank, correlation analysis showed a significant relationship between proton density fat fraction magnetic resonance imaging and HSI (r=0.40; P<0.0001) and FLI (r=0.27; P<0.0001).

RDN significantly reduced HSI and FLI in patients with uncontrolled hypertension and cardiometabolic comorbidities, suggesting a potential role of sympathetic modulation in metabolic disorders.