Clinical significance of low-grade renal artery stenosis.
BACKGROUND
Patients with a renal artery stenosis (RAS) >50% carry an increased risk for future cardiovascular (CV) events. Experimental literature on this topic suggests that this might as well be true for subjects with lower-grade RAS.


METHODS
Recruitment in this longitudinal cohort study was conducted from 1982 to 2002 in a Dutch University Hospital. Included in this study were 301 hypertensive patients clinically suspected of having RAS. Study participants were radiologically classified as having no, a low-grade (<50% lumen narrowing) or high-grade (> or =50%) RAS. A predetermined composite CV end-point was defined as one of the following: myocardial infarction or 'objectified' angina pectoris, ischaemic stroke or death from any CV cause. Other end-points were the occurrence of CV complications, all-cause plus CV mortality and decline in renal function.


RESULTS
During a median follow-up of 8.2 years, the incidence of the composite end-point totalled 79 events. After full adjustment in Cox models, a significant risk increase in high-grade [hazard ratio (HR) 2.81; P = 0.002] and low-grade RAS (HR 2.32; P = 0.038) was observed. Other end-points did not differ significantly between study groups.


CONCLUSIONS
Hypertensive subjects with RAS of any extent, compared with hypertensives without RAS, carry a substantially increased risk for future CV events. Therefore, even in patients with low-grade RAS, aggressive pharmacological treatment strategies should be adopted as a preventive measure.
Dechering
D G
DG
Department of General Internal Medicine, University Medical Centre, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.
Kruis
H M E
HM
Adiyaman
A
A
Thien
Th
T
Postma
C T
CT
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011859:Radiography; D012078:Renal Artery Obstruction / Q000150:complications* / Q000000981:diagnostic imaging; D012307:Risk Factors
D000959:Antihypertensive Agents