Renal artery stenosis in patients with resistant hypertension.
Am J Cardiol. 2013 Nov 1;112(9):1417-20
Authors: Protasiewicz M, Kądziela J, Początek K, Poręba R, Podgórski M, Derkacz A, Prejbisz A, Mysiak A, Januszewicz A, Witkowski A
Abstract
The aim of the study was to assess the significance of renal translesional pressure gradients in predicting improvement in resistant hypertension after stenting for moderate renal artery stenosis (RAS). In 37 patients with RAS and resistant hypertension subjected to renal stenting, translesional pressure gradients both at rest and hyperemic were measured using a pressure guidewire. Twenty-four-hour ambulatory blood pressure measurements were performed in all patients on admission and 3 months after the intervention. Angioplasty was successful in all patients, with reduction of artery diameter stenosis from 60 ± 12% to 10 ± 6% (p <0.0001). At 3 months, with maintained hypotensive agents (4.0 ± 1.4 vs 4.0 ± 1.6), significant reductions in systolic blood pressure (SBP) and diastolic blood pressure were noted (-5 and -2 mm Hg, respectively). In multivariate analysis, the mean baseline gradient (MBG) was the only independent predictor of improvement in SBP (regression coefficient 0.292; standard error 0.11; p value 0.014). In the receiver operating characteristic curve analysis, MBG had a larger area under the curve than other parameters, and the MBG >22 mm Hg had the highest sensitivity, specificity, and accuracy (50%, 95%, and 0.74%, respectively) in predicting hypertension improvement after stenting. In patients with MBG >22 mm Hg, SBP decreased by 12 versus 3 mm Hg (p <0.01) in patients with MBG ≤22 mm Hg, whereas diastolic blood pressure in both groups decreased by 3 versus 1 mm Hg, respectively (NS). In conclusion, MBG value of >22 mm Hg provides the highest accuracy in predicting hypertension improvement after stenting for moderate RAS in patients with resistant hypertension.
PMID: 24135303 [PubMed - in process]