Screening for Renovascular Hypertension in a Population With Relatively Low Prevalence

Helin, Kristian; Tikkanen, I.; Knorring, J E von; Lepäntalo, Mauri; Liewendahl, B. Kristian; Laasonen, Leena; Fyhrquist, Frej; Tikkanen, Tuula

doi:10.1097/00005392-199909010-00098

Cited by 8 publications

(10 citation statements)

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“…Recently, some researchers have used unresponsiveness of hypertension (diastolic blood pressure ≥95 mmHg) to two antihypertensive agents as a criterion for suspecting renovascular hypertension [15, 16]. We have previously shown that using this criterion is cost‐effective when selecting patients for screening of renovascular hypertension [17]. The present study confirms the concept that screening for renovascular hypertension and invasive treatment of RAD are justified only if diastolic blood pressure cannot be managed with two antihypertensive drugs.…”

Section: Discussionsupporting

confidence: 81%

Predicting the outcome of invasive treatment of renal artery disease

Helin¹,

Lepäntalo²,

Edgren³

et al. 2000

Journal of Internal Medicine

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Abstract. Helin KH, Lepa Èntalo M, Edgren J, Liewendahl K, Tikkanen T, Tikkanen I (Helsinki University Hospital, Helsinki, Finland). Predicting the outcome of invasive treatment of renal artery disease. J Intern Med 2000; 247: 105±110.Objective. Analysis of the factors influencing the outcome of performed or attempted invasive treatment for renal artery disease (RAD). Setting. University Hospital. Study patients. Thirty-five hypertensive patients with 31 stenoses and 14 occlusions of renal artery. Interventions. Angioplasty was performed on 25 patients (attempted for 30), primary stenting on one, nephrectomy on three, and renal resection on one patient. Main outcome measure. A decrease of diastolic blood pressure (DBP) by $15 mmHg after intervention. Results. A DBP response was seen in 24 patients. In 11 patients, invasive treatment did not result in a DBP response or failed technically. Compared with these patients, the responders were younger (55 6 11 vs. 66 6 8 years, P = 0.001) and tended to have higher DBP (100 6 8 vs. 93 6 11 mmHg, P = 0.065). The function of the affected kidney, or that of the more affected kidney if RAD was bilateral, was better preserved in responders (relative clearance on captopril renography 23 6 15 vs. 8 6 4%, P = 0.008). A response was more often seen in unilateral than in bilateral RAD (81% vs. 33%, P = 0.015). A relative clearance of #10% on captopril renography had sensitivity of 88% and specificity of 81% for renal artery occlusion.Step-wise logistic analysis. (1) When DBP was, 95 mmHg with two antihypertensives, the response rate was 1/6 vs. 24/29 for more severe hypertension (P = 0.004). (2) Elderly patients had a response rate of 2/5 vs. 22/24 in younger patients (P = 0.024). (3) Response rates in bilateral and unilateral disease were not different, nor did the function of the affected kidney impact the DBP response. However, three of the four responders with #10% relative clearance had an occluded renal artery and underwent nephrectomy. Conclusions. Middle-aged patients with easily controlled hypertension and elderly hypertensives do not usually have a blood pressure response to the performed or attempted invasive treatment of RAD. Therefore, it seems recommendable not to screen such patients for RAD, unless their renal function is deteriorated. If the affected kidney functions poorly on captopril renography, angioplasty is usually not applicable and seldom leads to a blood pressure response.

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Section: Discussionsupporting

confidence: 81%

Predicting the outcome of invasive treatment of renal artery disease

Helin¹,

Lepäntalo²,

Edgren³

et al. 2000

Journal of Internal Medicine

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“…One to three days later, a captopril challenge test (CCT) was carried out as described earlier [22]. This test was carried out in a total of 313 patients, and was performed at the inpatient ward in 229 cases and at the outpatient ward in 84 cases.…”

Section: Methodsmentioning

confidence: 99%

Common variants of the beta and gamma subunits of the epithelial sodium channel and their relation to plasma renin and aldosterone levels in essential hypertension

et al. 2005

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“…Prolongation of the time to reach maximal activity (Tmax) and asymmetry in renal handling of isotope were criteria for further screening for RVH (14). Patients with abnormal renograms were admitted to hospital for renal arteriography and other investigations.…”

Section: Renovascular Hypertensionmentioning

confidence: 99%

Prospective Study on the Prevalence of Secondary Hypertension among Hypertensive Patients Visiting a General Outpatient Clinic in Japan

et al. 2004

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Secondary hypertension (SH) including endocrine hypertension has been reported to be uncommon. We estimated the prevalence of SH among hypertensive patients. We prospectively studied 1,020 hypertensive patients. As an initial screening, we measured plasma aldosterone concentration, plasma renin activity, serum cortisol concentration and plasma catecholamine concentration and conducted abdominal ultrasonography

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Screening for Renovascular Hypertension in a Population With Relatively Low Prevalence

Cited by 8 publications

References 0 publications

Predicting the outcome of invasive treatment of renal artery disease

Predicting the outcome of invasive treatment of renal artery disease

Common variants of the beta and gamma subunits of the epithelial sodium channel and their relation to plasma renin and aldosterone levels in essential hypertension

Prospective Study on the Prevalence of Secondary Hypertension among Hypertensive Patients Visiting a General Outpatient Clinic in Japan

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