Resistant Hypertension and Atherosclerotic Renal Artery Stenosis

Abstract

The effect of renal artery angioplasty on blood pressure in patients with true resistant hypertension and atherosclerotic renal artery stenosis has not been fully investigated due to the exclusion of these patients from most trials. In this study, we assessed the benefits of renal angioplasty on daytime ambulatory blood pressure (dABP) in this subgroup of patients. Medical records of our hypertension department were retrospectively analyzed from 2000 to 2016. Seventy-two patients were identified with resistant hypertension (dABP >135 or 85 mm Hg despite at least 3 antihypertensive drugs, including a diuretic) and atherosclerotic renal artery stenosis treated by angioplasty. Atherosclerotic renal artery stenosis was unilateral in 57 patients and bilateral in 15 patients. The mean age of the patients was 67.8±11.2 years; dABP was 157±16/82±10 mm Hg despite 4.0±1.0 antihypertensive treatments; estimated glomerular filtration rate was 52 (41–63) mL/min. After renal angioplasty, dABPM decreased by 14.0±17.3/6.4±8.7 mm Hg ( P <0.001 for both), and the number of antihypertensive treatments decreased to 3.6±1.4 ( P =0.002) with no significant change in estimated glomerular filtration rate. A high baseline systolic dABP and a low body mass index were independent predictors of systolic dABP changes. The decrease in dABP was confirmed in a subgroup of patients at one and 3 years of follow-up (N=31 and N=18 respectively, P ≤0.001 for systolic and diastolic blood pressure at both visits). In this retrospective uncontrolled single-center study, angioplasty in patients with atherosclerotic renal artery stenosis and with true resistant hypertension significantly decreased dABP, reducing the need for antihypertensive treatment with no change in estimated glomerular filtration rate.

Revascularization for Renovascular Disease: A Scientific Statement From the American Heart Association

“…In some institutions, identification of candidates for revascularization is performed as a joint clinical review by multiple specialty physicians 53 or documentation of apparent treatment-resistant hypertension by ambulatory blood pressure monitoring, or both. 37 These reports emphasize the importance of both accurate assessment of vascular occlusion and the clinical manifestations and competing risks in considering revascularization. 52 Characteristics and clinical features in patients observed to benefit from renal revascularization are summarized in Table 2 and are addressed in the following sections.…”

“…Dotted line depicts group mean fall in ambulatory blood pressure monitor systolic blood pressure of -14 mm Hg. Adapted with permission from Courand et al 37 Copyright 2019 American Heart Association, Inc. August 2022 e133…”

Short Term Prognosis of Renal Artery Stenosis Secondary to Acute Type B Aortic Dissection With TEVAR

“…Nondissection-related RAS seriously affects the prognosis of patients and is a key factor in the risk model of prognosis (19). Previous studies on non-dissection-related RAS have mostly focused on atherosclerosis (20,21). The main innovation of this study is ability to distinguish the dissection-related RAS population from the RAI group.…”

<p>Severely Impaired Renal Function in Unilateral Atherosclerotic Renal Artery Stenosis Indicated by Renal Slow Perfusion</p>

“…3 The average eGFR of the population was under 60 mL/min in three other clinical studies. 4,14,15 Although RAS leads to renal dysfunction, the exact level of reduced renal perfusion can lead to hemodynamic changes. Visual assessment is widely used in diagnosing vascular diseases, but it is not accurate alone in evaluating the stenotic degree of lesions.…”