Renal denervation improves metabolic parameters and reduces SCORE2-estimated cardiovascular risk in uncontrolled hypertension

Background and Aims Sympathetic nervous system overactivity is a key pathophysiological mechanism in hypertension and is closely associated with adverse metabolic alterations, including dyslipidaemia and impaired glucose metabolism. Renal denervation (RDN) is an established adjunctive treatment for uncontrolled hypertension with proven blood pressure-lowering efficacy. Emerging evidence suggests that sympathetic modulation by RDN may also influence metabolic pathways. This study aimed to evaluate metabolic changes following RDN and to assess estimated cardiovascular risk in a primary prevention subgroup. Methods This single-centre post-hoc analysis included 122 patients with uncontrolled hypertension who underwent radiofrequency-, ultrasound-, or alcohol-based renal denervation. Fasting glucose, HbA1c, and lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and non-HDL cholesterol) were assessed at baseline and 6 months after the procedure. In a predefined primary prevention subgroup (n=61), 10-year cardiovascular risk was calculated using SCORE2 (Systematic COronary Risk Evaluation 2)). Results At 6-month follow-up, fasting glucose decreased significantly compared with baseline (14.9 ±47.3 mg/dL; p=0.031), whereas HbA1c remained unchanged. Significant improvements were observed in lipid parameters, including reductions in total cholesterol (10.3 ± 26.3 mg/dL), LDL cholesterol (7.0 ± 20.4 mg/dL), triglycerides (30.7 ± 69.4 mg/dL), and non-HDL cholesterol (all p<0.01). Blood pressure was significantly reduced at follow-up, both for office measurements (13.5 ± 19.5/7.0 ± 11.7 mmHg) and 24-hour ambulatory blood pressure (7.0 ± 15.0/4.5 ± 9.2 mmHg; both p<0.001). In the primary prevention subgroup, median 10-year SCORE2 risk decreased significantly from 14.1% at baseline to 11.3% at 6 months (p<0.001), predominantly driven by systolic blood pressure reduction. Among 29 patients initially at High or Very High SCORE2 risk, 12 (41%) were reclassified to a lower risk category. Conclusion Renal denervation was associated with significant improvements in metabolic parameters and blood pressure in patients with uncontrolled hypertension. In patients without prior cardiovascular events, these changes were accompanied by a significant reduction in calculated SCORE2 risk, reflecting an overall improvement in cardiovascular risk factor profile.