Document Detail


Predicting blood pressure response after renal artery stenting.
MedLine Citation:
PMID:  19939607     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although technical success of renal artery stenting (RAS) is high and adverse events are infrequent, clinical success (improved blood pressure and renal function) and durability have been less predictable. Identifying those patients who will respond to RAS could improve overall outcomes of the procedure.
METHODS: This was a retrospective analysis of all patients who underwent RAS for treatment of renovascular hypertension (RVH) between 2001 and 2007 at Dartmouth-Hitchcock Medical Center. The primary outcome measure was blood pressure improvement or cure as judged by American Heart Association criteria. Estimated glomerular filtration rate (eGFR), number of antihypertensive medications, and survival were evaluated as secondary outcomes. Univariate and multivariate analyses were performed to identify factors associated with blood pressure improvement at the last follow-up.
RESULTS: During the 6-year period, 129 patients (179 renal arteries) underwent stent placement for RVH. Procedural complications occurred nine patients (7.0%). Average length follow-up was 1.5 years. Follow-up data were obtained in 122 patients (95%). At last follow-up, there were significant improvements in systolic blood pressure (161 vs 144 mm Hg, P < .001), diastolic blood pressure (80 vs 73 mm Hg, P < .001), and number of antihypertensive medications (3.1 vs 2.8, P = .034). The eGFR was improved in 16% of patients, stable in 60%, and worse in 24%. By multivariate analysis, a baseline eGFR <40 mL/min/1.73 m2 (odds ratio, 1.6; 95% confidence interval [CI], 1.0-2.9; P = .02) and female gender (OR, 1.3; 95% CI, 1.0-2.1; P = .04) were independent predictors of failure to achieve blood pressure improvement. By 2 and 4 years of follow-up, sustained blood pressure improvement was present in 67% of patients with a baseline eGFR of > or = 40 mL/min/1.73 m2 and in 31% of patients with a baseline eGFR <40 mL/min/1.73 m2. During 2 years of follow-up, survival was similar between patients with sustained blood pressure response and those without.
CONCLUSION: Patients treated for RVH who have a baseline eGFR of > or = 40 mL/min/1.73 m2 demonstrate a better response to RAS at each follow-up interval, with a significant difference at 2 to 4 years, compared with patients with an eGFR <40 mL/min/1.73 m2.
Authors:
Adam W Beck; Brian W Nolan; Randall De Martino; Theodore H Yuo; William J Tanski; Daniel B Walsh; Richard P Powell; Jack L Cronenwett
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Publication Detail:
Type:  Journal Article     Date:  2009-11-24
Journal Detail:
Title:  Journal of vascular surgery     Volume:  51     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-09     Completed Date:  2010-03-04     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:  380-5; discussion 385     Citation Subset:  IM    
Copyright Information:
Copyright 2010. Published by Mosby, Inc.
Affiliation:
Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon / adverse effects,  instrumentation*,  mortality
Antihypertensive Agents / therapeutic use
Blood Pressure*
Female
Glomerular Filtration Rate
Humans
Hypertension, Renovascular / etiology,  mortality,  physiopathology,  therapy*
Kaplan-Meier Estimate
Male
Middle Aged
Odds Ratio
Patient Selection
Renal Artery Obstruction / complications,  mortality,  physiopathology,  therapy*
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Sex Factors
Stents*
Time Factors
Treatment Failure
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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