Pleiotropic effects of renal denervation beyond blood pressure reduction

Overactivation of sympathetic nervous system (SNS) has a key role in the pathophysiology of hypertension, as well as in chronic kidney disease, heart failure, atrial fibrillation, type 2 diabetes mellitus, obstructive sleep apnea, and anxiety disorders. Renal denervation (RDN) has been proven to lower blood pressure (BP) in hypertensive patients by reducing SNS activity. Beyond hypertension, data from a limited number of preclinical studies and clinical trials suggest that RDN may also be nephroprotective, have beneficial hemodynamic and clinical effects in patients with heart failure, reduce the burden of atrial fibrillation, have a moderate beneficial effect on glucose metabolism, and decrease the severity of obstructive sleep apnea. This study reviews the potential pleiotropic effects of RDN in these diseases that are characterized by SNS overactivation, and highlights the need for further well-designed, large-scale clinical trials to define the extent of these effects, clarify their clinical significance, and determine how they relate to RDN-induced changes in blood pressure.