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A Journal on Heart and Vascular Diseases
Official Journal of the Italian Society of Angiology and Vascular Pathology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,752
Minerva Cardioangiologica 2011 December;59(6):533-42
In high risk hypertensive subjects with incidental and unilateral renal artery stenosis percutaneous revascularization with stent improves blood pressure control but not glomerular filtration rate
Mazza A. 1, Rigatelli G. 2, Piva M. 3, Rampin L. 4, Cardaioli P. 2, Giordan M. 2, Roncon L. 5, Zattoni L. 6, Zuin M. 1, Al-Nahhas A. 7, Rubello D. 4, Ramazzina E. 1, Ravenni R. 9, Casiglia E. 8 ✉
1 Department of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy;
2 Interventional Cardiology Unit, Division of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy;
3 Unit of Nephrology, Santa Maria della Misericordia Hospital, Rovigo, Italy;
4 Service of Nuclear Medicine and PET/CT Centre, Department of Imaging, Santa Maria della Misericordia Hospital, Rovigo, Italy;
5 Division of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy;
6 Department of Imaging, Santa Maria della Misericordia Hospital, Rovigo, Italy;
7 Department of Nuclear Medicine, Hammersmith Hospital, London, UK;
8 Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
9 Department of Neuroscience, Santa Maria della Misericordia Hospital, Rovigo, Italy
AIM:In high-risk hypertensive subjects (HTs) with incidental unilateral renal artery stenosis (RAS), the effectiveness of percutaneous revascularization with stent (PR-STENT) on blood pressure (BP) and glomerular filtration rate (GFR) is not established.
METHODS: Eighteen HTs aged 65.7±9.2 years with angiographically diagnosed unilateral RAS (≥60%) were randomized to receive PR-STENT (N=9) or to NO-STENT (N=9). BP (mercury sphygmomanometer) and GFR (99mTc-DTPA clearances during renal scintigraphy) were evaluated yearly for three years. Echo-Doppler of renal arteries was performed to verify the anatomic patency and flow velocities of the reperfused artery. Analysis of variance compared BP and GFR values changes from baseline to the follow-up; differences for continuous variables were evaluated between groups with the Tukey’s post hoc test after adjustment for age, change of BP between baseline and at the follow-up, GFR and body mass index (BMI).
RESULTS: Baseline systolic BP and GFR values were not different between groups. The significantly greater GFR increase observed in PR-STENT than in NO-STENT at univariate analysis at the end of follow-up (62.5±19.2 vs. 42.24±17.6, P<0.02) disappeared after adjustment for confounding factors. However, systolic BP remained significantly lower in PR-STENT than in NO-STENT (140.1±4.6 vs. 170.0±8.3, P<0.0001) also after adjustment for age, GFR and BMI.
CONCLUSION:PR-STENT reduces systolic BP without improving GFR. Due to the strong association between high BP and renal damage, this study raises the question on whether PR-STENT should be performed in all HTs with unilateral and incidental RAS.