| Assessing outcomes to determine whether symptoms related to hypertension justify renal artery stenting. | |
| | |
MedLine Citation:
|
PMID: 22133456 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: The goal of the study was to determine the blood pressure (BP) response to renal artery stenting (RAS) for patients with hypertension urgency, hypertension emergency, and angina with congestive heart failure (angina/congestive heart failure [CHF]). METHODS: Patients who underwent RAS for hypertension emergencies (n = 13), hypertension urgencies (n = 25), and angina/CHF (n = 14) were included in the analysis. By convention, hypertension urgency was defined by a sustained systolic BP ≥ 180 mm Hg or diastolic BP ≥ 120 mm Hg, while the definition of hypertension emergency required the same BP parameters plus hypertension-related symptoms prompting hospitalization. Patient-specific response to RAS was defined according to modified American Heart Association reporting guidelines. RESULTS: The study cohort of 52 patients had a median age of 66 years (interquartile range 58-72). The BP response to RAS varied significantly according to the indication for RAS. Hypertension emergency provided the highest BP response rate (85%), while the response rate was significantly lower for hypertension urgency (52%) and angina/CHF (7%; P = .03). Only 1 of 14 patients with angina/CHF was a BP responder. Multivariate analysis showed that hypertension urgency or emergency were not independent predictors of BP response to RAS. Instead, the only independent predictor of a favorable BP response was the number of preoperative antihypertensive medications (odds ratio 7.5; 95% confidence interval 2.5-22.9; P = .0004), which is another indicator of the severity of hypertension. Angina/CHF was an independent predictor of failure to respond to RAS (odds ratio 118.6; 95% confidence interval 2.8-999.9; P = .013). CONCLUSIONS: Hypertension urgency and emergency are clinical manifestations of severe hypertension, but the number of preoperative antihypertensive medications proved to be a better predictor of a favorable BP response to RAS. In contrast, angina/CHF was a predictor of failure to respond to stenting, providing further evidence against the practice of incidental stenting during coronary interventions. |
| | |
Authors:
|
J Gregory Modrall; Eric B Rosero; Carlos H Timaran; Thomas Anthony; Jayer Chung; R James Valentine; Clayton Trimmer |
Related Documents
:
|
21746766 - Effect of fixed-dose losartan/hydrochlorothiazide on brain natriuretic peptide in patie... 21949626 - Intravenous clevidipine for management of hypertension. 22185726 - Intravenous esmolol infusion improves surgical fields during sevoflurane-anesthetized e... 22026256 - Comparing different treatment schedules of zomen (zofenopril). 9869006 - Ambulatory blood pressure in the hypertensive population: patterns and prevalence of hy... 1995046 - Postural studies in pulsatile ocular blood flow: ii. chronic open angle glaucoma. |
Publication Detail:
|
Type: Journal Article Date: 2011-12-01 |
Journal Detail:
|
Title: Journal of vascular surgery Volume: 55 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2012 Feb |
Date Detail:
|
Created Date: 2012-01-23 Completed Date: 2012-03-12 Revised Date: 2012-10-03 |
Medline Journal Info:
|
Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 413-9; discussion 419-20 Citation Subset: IM |
Copyright Information:
|
Copyright © 2012 Society for Vascular Surgery. All rights reserved. |
Affiliation:
|
Dallas Veterans Affairs Medical Center, University of Texas Southwestern Medical School, Dallas, TX, USA. gmodrall@uams.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Angina Pectoris / etiology, therapy Angioplasty, Balloon / adverse effects, instrumentation*, mortality Antihypertensive Agents / therapeutic use Blood Pressure* / drug effects Chi-Square Distribution Emergencies Heart Failure / etiology, therapy Humans Hypertension / complications, diagnosis, mortality, physiopathology, therapy* Hypertension, Renovascular / complications, diagnosis, mortality, physiopathology, therapy* Kaplan-Meier Estimate Logistic Models Middle Aged Odds Ratio Patient Selection Retrospective Studies Risk Assessment Risk Factors Severity of Illness Index Stents* Texas / epidemiology Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
0/Antihypertensive Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Evidence for nonoperative management of acute limb ischemia in infants.
Next Document: Isoxazoles incorporated N-substituted decahydroquinolines: A precursor to the next generation antimi...