Diffusion of new technology for the treatment of renovascular hypertension in the United States: surgical revascularization versus catheter-based therapy, 1988-2001.
BACKGROUND
Trends in the management of renovascular hypertension were evaluated by using a representative national database to determine whether a shift in treatment technology and outcomes has occurred.


METHODS
Clinical information regarding the treatment of renovascular hypertension in 5433 patients from 1988 to 2001 was derived from the Nationwide Inpatient Sample (NIS) database. Patients were classified into 3 groups: combined aortic and renal revascularization, isolated renal revascularization, and catheter-based procedures (angioplasty with or without stenting). Population-based trends were determined by using sampling weights for each year to estimate the total number of each intervention in the United States. Outcomes were compared using multivariate logistic regression analysis for risk-adjustment.


RESULTS
A 73% decrease in combined aortic and renal revascularizations ( P = .033) and a 56% decrease in isolated renal revascularizations ( P < .001) occurred during the study period. Catheter-based procedures have increased 173% from 0.4 to 1.1 procedures per 100,000 adults during this same time period ( P < .001). Predictors favoring catheter-based treatment were admission acuity, increasing age, nonwhite race, and high socioeconomic status. Predictors of mortality for all 3 treatment groups included increasing age, emergent admission, and nonwhite race.


CONCLUSIONS
A significant change in the management of patients with renovascular hypertension has occurred, with a shift towards less invasive catheter-based interventions. A better understanding of the diffusion of this technology in the treatment of individuals with renovascular hypertension will influence the training and distribution of future vascular specialists responsible for these patients.
Knipp
Brian S
BS
Section of Vascular Surgery, Departmetn of Surgery, University of Michigan Medical Center, Ann Arbor, USA.
Dimick
Justin B
JB
Eliason
Jonathan L
JL
Cowan
John A
JA
Henke
Peter K
PK
Proctor
Mary S
MS
Stanley
James C
JC
Upchurch
Gilbert R
GR
D000368:Aged; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data* / Q000639:trends; D001011:Aorta; D002404:Catheterization / Q000706:statistics & numerical data / Q000639:trends; D019992:Databases as Topic; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000706:statistics & numerical data / Q000639:trends; D012078:Renal Artery Obstruction / Q000628:therapy*; D015607:Stents; D013673:Technology Assessment, Biomedical; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends