title: Stent-supported angioplasty of severe atherosclerotic renal artery stenosis preserves renal function and improves blood pressure control: long-term results from a prospective registry of 456 lesions.
abstract: OBJECTIVE
  To report a prospective study evaluating the long-term impact of stent-supported angioplasty on renal function and blood pressure control.
  
  
  METHODS
  In a 6-year period, 456 hemodynamically significant de novo renal artery stenoses > or =70% were treated in 340 consecutive hypertensive patients (223 men; mean age 66+/-10 years, range 44-84) with or without impaired renal function. Baseline data on serum creatinine (sCr), intrarenal resistance index, ambulatory 24-hour blood pressure monitoring, and documentation of the number and dose of antihypertensive drugs were compared to values obtained during follow-up. The primary endpoint was a 10% decrease in sCr; the glomerular filtration rate and changes in blood pressure control were additional outcome measures.
  
  
  RESULTS
  During a mean follow-up of 34+/-20 months, sCr decreased significantly from 1.45+/-0.87 to 1.39+/-0.73 mg/dL (p=0.048). In 34% of the patients, sCr decreased >10%, 39% were unchanged, and 27% had an increase >10%. Glomerular filtration rate increased from 59+/-26 to 62+/-26 mL/min/1.73 m(2) (p=0.6). Systolic, diastolic, and mean blood pressure measurements significantly improved immediately after the intervention (132/72/93 versus 144/79/102 mmHg at baseline, p<0.0001) and remained improved during follow-up (p<0.0001). Blood pressure control was improved in 46%, unchanged in 43%, and deteriorated in 11%. Baseline sCr, bilateral intervention, percent diameter stenosis, and 3-vessel coronary disease were independent predictors of improved renal function during follow-up; the number of antihypertensive drugs taken before the intervention predicted improved blood pressure control.
  
  
  CONCLUSIONS
  Stent-supported angioplasty of renal artery stenoses preserves renal function and improves blood pressure control in a broader spectrum of patients than previously thought.
authors.affiliation: Department of Angiology, Bad Krozingen Heart Center, Südring 15, D-79189 Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frank
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Bürgelin
authors.forename: Lutz
authors.initials: L
authors.lastname: Sinn
authors.forename: Barbara
authors.initials: B
authors.lastname: Horn
authors.forename: Peter-Christian
authors.initials: PC
authors.lastname: Flügel
authors.forename: Uwe
authors.initials: U
authors.lastname: Schwarzwälder
authors.forename: Helmut
authors.initials: H
authors.lastname: Roskamm
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D001161:Arteriosclerosis / Q000628:therapy*; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012078:Renal Artery Obstruction / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014655:Vascular Resistance
chemical_list: D003404:Creatinine