Blood pressure decreases after revascularization in atherosclerotic renal artery disease: A cohort study based on a multidisciplinary meeting

Abstract

Background In atherosclerotic renal artery disease, the benefit of revascularization is controversial. A clinical decision-making process based on a multidisciplinary meeting was formalized in the Lyon university hospital. Objectives To investigate whether this decisional process ensured a clinical benefit to patients assigned to renal revascularization. Methods Single-centre retrospective cohort study, including patients diagnosed from April 2013 to February 2015 with an atherosclerotic renal artery disease with a peak systolic velocity >180cm/s. For each patient, the decision taken in multidisciplinary meeting (medical treatment or revacularization) was compared to the one guided by international guidelines. Blood pressure values, number of antihypertensive medications, presence of an uncontrolled or resistant hypertension, and glomerular filtration rate at one-year follow-up were compared to baseline values. Safety data were collected. Results Forty-nine patients were included: 26 (53%) were assigned to a medical treatment and 23 (47%) to a renal revascularization. Therapeutic decision was in accordance with the 2013 American Health Association guidelines and with the 2017 European Society of Cardiology guidelines for 78% and 22% of patients who underwent revascularization, respectively. Patients assigned to revascularization presented a significant decrease in systolic blood pressure (-23±34mmHg, p = 0.007), diastolic blood pressure (-12±18mmHg, p = 0.007), number of antihypertensive medications (-1.00±1.03, p = 0.001), and number of uncontrolled or resistant hypertension ( p = 0.022 and 0.031) at one-year follow-up. Those parameters were not modified among patients assigned to medical treatment alone. There was no grade 3 adverse event. Conclusion Based on a multidisciplinary selection of revascularization indications, patients on whom a renal revascularization was performed exhibited a significant improvement of blood pressure control parameters with no severe adverse events.

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

“…Additional outcomes of interest include slowing the progression of chronic kidney disease and treatment of heart failure. 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.…”

Managing acute presentations of atheromatous renal artery stenosis

“…There was also a reduction of antihypertensive agents and the number of cases of resistant hypertension at one year follow up. There was no change in those assigned to medical treatment [11].…”

Atherosclerotic Renovascular Disease: A KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference

“…RCTs would be particularly valuable in patients with chronic HF and those with a combination of deteriorating kidney function and severe hypertension. In the meantime, the results of real-world renal revascularization practice in these higher-risk phenotypes from individual centers 76 are of value and should be aggregated, but carefully curated to minimize bias.…”