Impact of Renal Denervation in Patients With Coronary Microvascular Dysfunction: Study Design and Rationale (IMPRESSION)

Rul-in Phase Inclusion Criteria: Non obstructive stable coronary artery disease (CAD) on invasive coronary angiography (defined as the absence of either >50% angiographic stenosis or any flow limiting lesion on functional evaluation) Suspected diagnosis of difficult to control/ resistant hypertension for which renal denervation by radiofrequency ablation with Spyral Symplicity 3 could be considered. Rule-in Phase Exclusion Criteria: Initiation of either nitrates, beta-blocker or calcium channel blocker less than 30 days before the end of the rule-in phase Physiological assessment performed during first medical contact documenting preserved coronary microvascular function Physiological assessment performed at the "first contact" hospitalization followed by modification of medical therapy during the rule-in phase, before RDN Acceptable blood pressure control after medical treatment optimization Identification of secondary causes of hypertension Renal artery anatomy not suitable for RDN Ejection fraction below 30% Life expectancy below 1 year Indication to cardiac surgery Adenosine allergy Pregnancy Large necrotic area documented by either MRI, SPECT or combination of ECG signs + Echocardiographic images. Hemodynamic instability Refuse to sign informed consent Age below 18 or above 80 Study Phase Inclusion Criteria: Having coronary microvascular dysfunction documented by invasive functional assessment (IMR>25 and or CFR < 2) Fulfilling all the rule-in phase inclusion criteria without any rule-in phase exclusion criteria Study Phase Exclusion Criteria: Refuse to sign informed consent Evidence of newly detected obstructive CAD on invasive coronary angiography performed 6 months after RDN