A year after treatment, 65% of patients with renovascular hypertension experienced improvement.
CHICAGO—Most patients with renovascular hypertension experience improved BP control and improved or stabilized renal function following renal artery angioplasty and stent placement, according to findings presented here at the American College of Cardiology annual meeting.
The study included 91 patients diagnosed with renovascular hypertension based on the presence of difficult-to-control arterial hypertension and significant renal artery stenosis (70% or greater) due to atherosclerosis. Patients had a mean age of 59.9 years; 47% were female; 77% were white. The mean duration of arterial hypertension was 159 months. Fifty-four percent were smokers, 28% had diabetes, 41% had dyslipidemia, and 40% had hyperuricemia.
Renal artery angioplasty and stent placement were performed in 104 arteries. The investigators, led by Luiz A. Bortolotto, MD, Hospital das Clinicas at the University of São Paolo in Brazil, evaluated hypertension and renal function after 12 months. Hypertension was considered cured if BP was below 140/90 mm Hg without drug therapy and improved if it was below 140/90 mm Hg or if there was a diastolic pressure reduction of 15 mm Hg on medication. Renal function was considered improved if patients had a 20% increase in GFR and impaired if they had a 20% decrease in GFR.
At 12 months of follow-up, 65% had improved BP, and 35% were considered treatment failures; 31% had improved renal function, 14% had impaired function, and 55% had stable function. Non-fatal cardiovascular events occurred in 26% of patients; 14% required dialysis; and 14% died over long-term follow-up. Age, gender, and renal function were the strongest predictors of outcome.
Before the intervention, 37% had CAD and 72% had left ventricular hypertrophy. Eighty-seven percent had grade 1 hypertensive retinopathy; 4% had grade 2, and 9% had grade 3. Peripheral artery disease was present in 30% of subjects. In addition, stage 1, 2, 3, 4, and 5 CKD was present in 4%, 22%, 38%, 26%, and 9% of patients, respectively.