Regression of left ventricular hypertrophy following stenting of renal artery stenosis.
OBJECTIVE
To determine if angioplasty of atherosclerotic renal artery stenosis, which reduces the activation of the renin-angiotensin-aldosterone system (RAAS), may lead to regression of left ventricular hypertrophy.


METHODS
The study included 102 patients (58 men; mean age 67 years, range 66-69) who underwent stent-supported percutaneous transluminal renal angioplasty (PTRA) and were included in a clinical follow-up program (mean 24+/-14 months, range 6-60). As a control group, 101 contemporaneous patients (68 men; mean age 68 years, range 66-70) with essential hypertension were investigated. The primary endpoint was the change in left ventricular mass index (LVMI) determined by echocardiography.


RESULTS
Mean follow-up intervals were 24+/-14 months (range 6-60) in the study group and 27+/-14 months (range 6-60) in the controls (p = 0.09). LVMI decreased significantly by -10+/-26 g/m(2) in the study group, while it increased significantly by 9+/-28 g/m(2) in the control group (p = 0.001 between groups). In the study group, mean arterial blood pressure was significantly reduced from 99+/-11 mmHg to 90+/-11 mmHg (p<0.0001) during follow-up despite a significant reduction in medication, whereas it increased significantly from 102+/-11 mmHg to 105+/-11 mmHg (p = 0.008) in the control group, although medication was significantly increased. After adjustment for various factors and covariables, PTRA prevailed as an independent predictor for regression of LVMI (p = 0.038).


CONCLUSIONS
PTRA induces regression of LVMI that is independent of the reduction in blood pressure induced by this procedure. Reduced activity of the RAAS may account for this regression.
Zeller
Thomas
T
Department of Angiology, Herz-Zentrum Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
Rastan
Aljoscha
A
Schwarzwälder
Uwe
U
Müller
Christian
C
Frank
Ulrich
U
Bürgelin
Karlheinz
K
Sixt
Sebastian
S
Schwarz
Thomas
T
Noory
Elias
E
Neumann
Franz-Josef
FJ
D000368:Aged; D000800:Angioplasty, Balloon; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D011379:Prognosis; D012078:Renal Artery Obstruction / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012084:Renin-Angiotensin System; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography