[Validity of the clinical prediction rule for the diagnosis of renal arterial stenosis in hypertensive patients resistant to treatment].
OBJECTIVE
To perform an external validation of the clinical prediction rule established by Krijnen et al. (Ann Intern Med 1998; 129: 705-11) designed to identify renal artery stenoses (RAS) in hypertensive patients.


METHODS
We included 102 patients with a refractory hypertension treated with at least two antihypertensive drugs. All subjects had the research of RAS by renal angiography, or angio-computed tomography, or doppler ultrasound. Probability to detect RAS was calculated with Krijnen's algorithm (Pre-test probability) from the following parameters: age, smoking status, diffuse atherosclerosis, recent hypertension (< 2 y), obesity (BMI > 25), abdominal bruit, hypercholesterolemia (> 6.5 mmol/L), creatinine. ROC curves were plotted for each pre-test probability value. A "post-test probability" was obtained from the likelihood ratio calculated at each pre-test probability level.


RESULTS
RAS prevalence in this population was 49%. Area under the ROC curve was 0.79 and Youden index was maximal for a pre-test probability of 15%. Maximal likelihood ratio was obtained for a pre-test probability of 46%. Table shows post-test probability as a function of pre-test probability obtained with Krijnen's algorithm. [table: see text]


CONCLUSIONS
Krijnen's algorithm is valid in a population of resistant hypertensives treated with a bi-therapy. This external validation obtained on a population with a high prevalence of RAS should also be tested on a population with a lower prevalence of SAR.
Marquand
A
A
Service de cardiologie, CHG de Fréjus-Saint-Raphaël.
Hanon
O
O
Fauvel
J P
JP
Mounier-Vehier
C
C
Equine
O
O
Girerd
X
X
D000367:Age Factors; D000465:Algorithms; D000792:Angiography; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001161:Arteriosclerosis / Q000150:complications; D003404:Creatinine / Q000097:blood; D004338:Drug Combinations; D005260:Female; D005544:Forecasting; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D015995:Prevalence; D012372:ROC Curve; D012077:Renal Artery / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler
D000959:Antihypertensive Agents; D004338:Drug Combinations; D003404:Creatinine