Effects of Percutaneous Transluminal Renal Angioplasty on Office and Home Blood Pressure and Home Blood Pressure Variability in Hypertensive Patients With Renal Artery Stenosis

Abstract

This study included 126 hypertensive patients with renal artery stenosis (mean age, 63 years; 22.2% fibromuscular dysplasia [FMD]) and investigated the effects of percutaneous transluminal renal angioplasty on office and home blood pressure (BP), and BP variability estimates derived from home BP, both at baseline and up to 12 months after angioplasty. Home BP was measured for 7 consecutive days, and the threshold defining uncontrolled home BP was ≥135/85 mm Hg. In both the FMD and atherosclerotic stenosis (ARAS) groups, office and home BP decreased significantly after angioplasty (all P <0.01), but the decrease in morning home (−22±19 versus −10±20 mm Hg; P <0.01) but not in office (−32±24 versus −23±28 mm Hg; P =0.11) systolic BP at 12 months was significantly greater in FMD. In both groups, all morning BP variability indices except the coefficient of variation in ARAS decreased significantly after revascularization (all P <0.05 by repeated-measures ANOVA). The decrease in all morning systolic BP variability estimates was greater for FMD than for ARAS (all P <0.05 by 2-way repeated-measures ANOVA), with the exception of variability independent of the mean ( P =0.11). The prevalence of uncontrolled home BP was 77.0% at baseline and 38.9% after revascularization. Duration of hypertension (odds ratio, 1.48), ARAS (odds ratio, 3.18), and the presence of proteinuria (odds ratio, 2.10) were independent predictors of uncontrolled home BP after revascularization (all P <0.05). In conclusion, renal angioplasty produced a greater decrease of morning home systolic BP in FMD; however, in both groups, it decreased BP variability irrespective of BP response. Measurement of home BP seems to be important for treatment success, especially in ARAS.

Difference between renal and splenic resistive index as a novel criterion in Doppler evaluation of renal artery stenosis

“…Although several trials demonstrated similar outcomes for revascularization and conservative treatment, [1][2][3][4] the detection of this entity of hypertension is still particularly therapy-relevant. At least in patients who present with "flash" pulmonary edema, congestive heart failure with preserved left ventricular function, or acute oligoanuric renal failure with global kidney ischemia, especially when they have severe bilateral RAS [5][6][7][8][9][10][11][12] as well as in patients with fibromuscular dysplasia. 13 The presence of a renal artery stenosis is also of importance in determining appropriate antihypertensive medical treatment, for instance the application of ACE-inhibitors or AT1-blockers in certain cases.…”

Impact of Percutaneous Transluminal Renal Angioplasty on Autonomic Nervous System and Natriuresis in Hypertensive Patients With Renal Artery Stenosis

“…Previous studies on predictors of improved out‐of‐office BP after PTA are limited, 33 , 34 , 35 but in most clinical guidelines, the indications for renal PTA consistently include hemodynamically significant renal artery stenosis and hypertension. 14 , 36 , 37 Studies of translesional pressure gradient in human subjects indicate that an aortic–renal pressure gradient of 10% to 20% is necessary to detect increased renin release, 38 which corresponds to a translesional peak gradient of at least 20 mm Hg and luminal stenosis of at least 70%.…”

A Unique Case of Renovascular Hypertension due to Fibromuscular Dysplasia in an Extra-renal Artery

“…In general, a higher morning home blood pressure relative to office blood pressure occurs because of a non-dipper pattern or a riser pattern of nocturnal blood pressure ( 9 ). A recent study reported that PTA significantly decreased both office and home morning and evening blood pressures and morning home systolic blood pressure variability ( 10 ). Our findings and previous data suggest that PTA may have beneficial effects on the actual blood pressures values and on the circadian rhythm.…”