title: Translesional pressure gradients to predict blood pressure response after renal artery stenting in patients with renovascular hypertension.
abstract: BACKGROUND
  In previous studies on the effect of renal stenting on arterial hypertension, patients were selected mainly on the basis of angiographic parameters of the renal artery stenosis. The aim of the present study was to evaluate whether translesional pressure gradients could identify the patients with renal artery stenosis who might benefit from stenting.
  
  
  RESULTS
  A total of 53 consecutive hypertensive patients with unilateral RAS scheduled for renal artery intervention were recruited. Transstenotic pressure gradients were measured at baseline and during maximal hyperemia, before renal artery stenting. Twenty-four-hour ambulatory blood pressure measurements were performed in all patients before and 3 months after the intervention. Average reductions in systolic blood pressure and diastolic blood pressure at follow-up were -20±30 mm Hg and -2±12 mm Hg, respectively. At multivariate analysis, dopamine-induced mean gradient was the only independent predictor of the variations of both systolic blood pressure (regression coefficient=-4.03, standard error=1.11; P<0.001) and diastolic blood pressure (regression coefficient=-3.11, standard error=1.20; P=0.009). Patients who showed a decline in systolic blood pressure from the baseline value >20 mm Hg were considered as "responders." The optimal cutoff for identification of "responders" was a dopamine-induced mean gradient ≥20 mm Hg (area under the curve, 0.77; 95% confidence interval, 0.64 to 0.90; P=0.001).
  
  
  CONCLUSIONS
  A dopamine-induced mean pressure gradient of ≥20 mm Hg is highly predictive of arterial hypertension improvement after renal stenting, and therefore this measurement is useful for appropriate selection of patients with arterial hypertension.
authors.affiliation: Cardiovascular Center, OLV-Clinic, Aalst, Belgium.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mangiacapra
authors.forename: Catalina
authors.initials: C
authors.lastname: Trana
authors.forename: Giovanna
authors.initials: G
authors.lastname: Sarno
authors.forename: Giedrius
authors.initials: G
authors.lastname: Davidavicius
authors.forename: Marcin
authors.initials: M
authors.lastname: Protasiewicz
authors.forename: Olivier
authors.initials: O
authors.lastname: Muller
authors.forename: Argyrios
authors.initials: A
authors.lastname: Ntalianis
authors.forename: Nerijus
authors.initials: N
authors.lastname: Misonis
authors.forename: Bruno
authors.initials: B
authors.lastname: Van Vlem
authors.forename: Guy R
authors.initials: GR
authors.lastname: Heyndrickx
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
mesh_terms: D000368:Aged; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000503:physiopathology*; D015607:Stents