title: Renal artery stenosis in patients with resistant hypertension.
abstract: The aim of the study was to assess the significance of renal translesional pressure gradients in predicting improvement in resistant hypertension after stenting for moderate renal artery stenosis (RAS). In 37 patients with RAS and resistant hypertension subjected to renal stenting, translesional pressure gradients both at rest and hyperemic were measured using a pressure guidewire. Twenty-four-hour ambulatory blood pressure measurements were performed in all patients on admission and 3 months after the intervention. Angioplasty was successful in all patients, with reduction of artery diameter stenosis from 60 ± 12% to 10 ± 6% (p <0.0001). At 3 months, with maintained hypotensive agents (4.0 ± 1.4 vs 4.0 ± 1.6), significant reductions in systolic blood pressure (SBP) and diastolic blood pressure were noted (-5 and -2 mm Hg, respectively). In multivariate analysis, the mean baseline gradient (MBG) was the only independent predictor of improvement in SBP (regression coefficient 0.292; standard error 0.11; p value 0.014). In the receiver operating characteristic curve analysis, MBG had a larger area under the curve than other parameters, and the MBG >22 mm Hg had the highest sensitivity, specificity, and accuracy (50%, 95%, and 0.74%, respectively) in predicting hypertension improvement after stenting. In patients with MBG >22 mm Hg, SBP decreased by 12 versus 3 mm Hg (p <0.01) in patients with MBG ≤22 mm Hg, whereas diastolic blood pressure in both groups decreased by 3 versus 1 mm Hg, respectively (NS). In conclusion, MBG value of >22 mm Hg provides the highest accuracy in predicting hypertension improvement after stenting for moderate RAS in patients with resistant hypertension.
authors.affiliation: Department of Cardiology, Medical University of Wroclaw, Wroclaw, Poland; Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland. Electronic address: mprot@poczta.onet.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Protasiewicz
authors.forename: Jacek
authors.initials: J
authors.lastname: Kądziela
authors.forename: Karol
authors.initials: K
authors.lastname: Początek
authors.forename: Rafał
authors.initials: R
authors.lastname: Poręba
authors.forename: Maciej
authors.initials: M
authors.lastname: Podgórski
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Derkacz
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.forename: Andrzej
authors.initials: A
authors.lastname: Mysiak
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
mesh_terms: D000368:Aged; D000792:Angiography; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D012372:ROC Curve; D012078:Renal Artery Obstruction / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology