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

Arterial hypertension is one of the most prevalent cardiovascular pathologies worldwide. Considering the increased rates of uncontrolled hypertension and treatment non-adherence, catheter-based methods, with the most prominent being renal denervation, have been recently included in international guidelines for the management of the pathology, naming the method the third pillar in hypertension management. However, sympathetic overactivation is not only a major pathophysiologic driver in hypertension, but in other cardiovascular pathologies as well. Considering the effect of renal denervation in hypertension-mediated target organ damage, as well as the pleotropic effects of this modality, recent evidence have evaluated the modality in coronary microvascular dysfunction (CMD). Interestingly, despite preclinical data showcase a benefit of renal denervation in microcirculatory homeostasis, with enhancement of endothelial-mediated vasodilation and reduction of inflammation, these effects have failed to be translated into clinical benefit, with the limited, to date, non-interventional studies in coronary microcirculation reporting neutral effects. Therefore, this review aims to delineate the pathophysiological processes which relate microvascular dysfunction with hypertension, discuss the effect of the procedure in hypertension-mediated target organ damage, analyze preclinical and clinical data on the safety and efficacy of renal denervation in improving microcirculatory indices, as well as provide future directions for this novel field.