Renal denervation improves hepatic steatosis in hypertensive patients with metabolic syndrome

Clin Res Cardiol (2026). DOI 10.1007/s00392-026-02870-1
M. Tokcan (Homburg/Saar)¹, M. Hohl (Homburg/Saar)¹, C. V. Schneider (Aachen)², K. M. Schneider (Dresden)³, P. Markwirth (Homburg/Saar)¹, B. Bernhard (Homburg)⁴, B. Haring (Wien)⁵, L. Lauder (Basel)⁶, J. Schattenberg (Homburg)⁷, F. Mahfoud (Basel)⁶, S. Kulenthiran (Homburg/Saar)¹, M. Böhm (Homburg/Saar)^1
1Universitätsklinikum des Saarlandes Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin Homburg/Saar, Deutschland; ²Uniklinik RWTH Aachen Med. Klinik III - Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin Aachen, Deutschland; ³Technische Universität Dresden Medizinische Klinik und Poliklinik I Dresden, Deutschland; ⁴Universitätsklinikum des Saarlandes Klinik für Innere Medizin III Homburg, Deutschland; ⁵Klinik Hietzing 4. Medizinische Abteilung - Innere Medizin mit Kardiologie Wien, Österreich; ⁶Universitätsspital Basel Abt. für Kardiologie Basel, Schweiz; ⁷Homburg, Deutschland

Background: Sympathetic overactivity associates with hepatic steatosis. Renal denervation (RDN) is an approved and recommended treatment of uncontrolled hypertension by reducing sympathetic activity, however its hepatic effects are unknown. This study aimed to assess the effects of RDN on changes in liver indices associated with hepatic steatosis.

Methods: This single-center study included patients with uncontrolled hypertension and cardiometabolic risk factors undergoing RDN (n=32) or sham procedure (n=10). Non-invasive scores of hepatic steatosis including the hepatic steatosis index (HSI) and fatty liver index (FLI) were calculated at baseline and follow ups. An external cohort from the UK Biobank was used to validate the correlation between proton density fat fraction (PDFF) MRI scans of the liver and these surrogates.

Results: Compared to the control group, RDN significantly reduced HSI at 3 months (0.4±1.6 vs. -1.3±1.8; p=0.009), 6 months (0.0±2.8 vs. -2.6±3.0; p=0.027) and 12 months (0.0±1.9 vs. -2.1±2.8; p=0.013) as well as FLI at 3 months (2.6±6.9 vs. -3.8±6.9; p=0.021), 6 months (4.2±7.5 vs. -5.7±6.8; p=0.002) and 12 months (2.0±8.7 vs. -6.2±7.1; p=0.018). No significant differences were found in HSI (-1.9±0.7 vs. -2.2±0.7; p=0.77) and FLI (-7.1±1.8 vs. -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 mmHg after 12 months. In the UK Biobank, correlation analysis showed a significant relationship between PDFF MRI and HSI (R=0.40; p<0.0001) and FLI (R=0.27; p<0.0001).

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