title: In high risk hypertensive subjects with incidental and unilateral renal artery stenosis percutaneous revascularization with stent improves blood pressure control but not glomerular filtration rate.
abstract: OBJECTIVE
  In high-risk hypertensive subjects (HTs) with incidental unilateral renal artery stenosis (RAS), the effectiveness of percutaneous revascularization with stent (PR-STENT) on blood pressure (BP) and glomerular filtration rate (GFR) is not established.
  
  
  METHODS
  Eighteen HTs aged 65.7 ± 9.2 years with angiographically diagnosed unilateral RAS (≥ 60%) were randomized to receive PR-STENT (N=9) or to NO-STENT (N=9). BP (mercury sphygmomanometer) and GFR (99mTc-DTPA clearances during renal scintigraphy) were evaluated yearly for three years. Echo-Doppler of renal arteries was performed to verify the anatomic patency and flow velocities of the reperfused artery. Analysis of variance compared BP and GFR values changes from baseline to the follow-up; differences for continuous variables were evaluated between groups with the Tukey's post hoc test after adjustment for age, change of BP between baseline and at the follow-up, GFR and body mass index (BMI).
  
  
  RESULTS
  Baseline systolic BP and GFR values were not different between groups. The significantly greater GFR increase observed in PR-STENT than in NO-STENT at univariate analysis at the end of follow-up (62.5 ± 19.2 vs. 42.24 ± 17.6, P<0.02) disappeared after adjustment for confounding factors. However, systolic BP remained significantly lower in PR-STENT than in NO-STENT (140.1 ± 4.6 vs. 170.0 ± 8.3, P<0.0001) also after adjustment for age, GFR and BMI.
  
  
  CONCLUSIONS
  PR-STENT reduces systolic BP without improving GFR. Due to the strong association between high BP and renal damage, this study raises the question on whether PR-STENT should be performed in all HTs with unilateral and incidental RAS.
authors: Department of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy. mazza.alberto@azisanrovigo.it
authors: A
authors: A
authors: Mazza
authors: G
authors: G
authors: Rigatelli
authors: M
authors: M
authors: Piva
authors: L
authors: L
authors: Rampin
authors: P
authors: P
authors: Cardaioli
authors: M
authors: M
authors: Giordan
authors: L
authors: L
authors: Roncon
authors: L
authors: L
authors: Zattoni
authors: M
authors: M
authors: Zuin
authors: A
authors: A
authors: Al-Nahhas
authors: D
authors: D
authors: Rubello
authors: E
authors: E
authors: Ramazzina
authors: R
authors: R
authors: Ravenni
authors: E
authors: E
authors: Casiglia
mesh_terms: D000368:Aged; D000465:Algorithms; D000704:Analysis of Variance; D000800:Angioplasty, Balloon; D001794:Blood Pressure; D001795:Blood Pressure Determination; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000628:therapy*; D033162:Incidental Findings; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography