Reduced medication and normalization of vascular structure, but continued hypertension in renovascular patients after revascularization.
OBJECTIVE
The effect of invasive treatment of renal artery stenosis on the use of antihypertensive medication, blood pressure, and morphology and function of resistance arteries was investigated in 14 renovascular hypertensive patients before and after treatment compared to normotensive controls.


METHODS
Use of antihypertensive medication was calculated as defined daily doses (DDD). Resistance arteries were taken from gluteal subcutaneous biopsies and analyzed in a myograph.


RESULTS
Prior to invasive treatment, blood pressure of the patients was elevated compared to normotensive controls. Six months after technically successful invasive treatment, patients were still hypertensive compared to time-matched controls. The use of antihypertensive medication was reduced from 4.4+/-0.7 DDD before invasive treatment to 3.0+/-0.6 DDD 6 months after treatment. Vascular structure of resistance arteries, expressed as media/lumen ratio (media thickness to diameter), was greater in patients before invasive treatment (10.7+/-1.0%) compared to normotensive controls (7.9+/-0.8%). Media/lumen ratio of resistance arteries was reduced to that of the controls 6 months after invasive treatment despite the remaining hypertension. The functional studies showed no difference in response to acetylcholine, adenosine, noradrenaline or angiotensin II between patients and controls before or after treatment.


CONCLUSIONS
This study shows that hypertension and increased media/lumen ratio of resistance arteries prevail in renovascular hypertensive patients despite antihypertensive medication and that invasive treatment is of benefit as regards use of antihypertensive medication. The study provides the novel information that the remaining hypertension is not due to uncorrected media/lumen ratio of the resistance arteries.
Kvist
S
S
Department of Nephrology, Hospital of Aalborg, Aalborg, Denmark. stinne.kvist@dadlnet.dk
Mulvany
M J
MJ
D000109:Acetylcholine / Q000494:pharmacology; D000241:Adenosine / Q000494:pharmacology; D000800:Angioplasty, Balloon; D000804:Angiotensin II / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001158:Arteries; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000187:drug effects; D009638:Norepinephrine / Q000494:pharmacology; D012077:Renal Artery / Q000601:surgery*; D012083:Renin / Q000097:blood; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
D000959:Antihypertensive Agents; D000804:Angiotensin II; D012083:Renin; D000241:Adenosine; D000109:Acetylcholine; D009638:Norepinephrine