title: Treatment of atherosclerotic renovascular hypertension: review of observational studies and a meta-analysis of randomized clinical trials.
abstract: Atherosclerotic renal artery stenosis can cause ischaemic nephropathy and arterial hypertension. We herein review the observational and randomized clinical trials (RCTs) comparing medical and endovascular treatment for control of hypertension and renal function preservation. Using the Population Intervention Comparison Outcome (PICO) strategy, we identified the relevant studies and performed a novel meta-analysis of all RCTs to determine the efficacy and safety of endovascular treatment when compared with medical therapy. The following outcomes were examined: baseline follow-up difference in mean systolic and diastolic blood pressure (BP), serum creatinine, number of drugs at follow-up, incident events (heart failure, stroke, and worsening renal function), mortality, cumulative relative risk of heart failure, stroke, and worsening renal function. Seven studies comprising a total of 2155 patients (1741 available at follow-up) were considered, including the recently reported CORAL Study. Compared with baseline, diastolic BP fell more at follow-up in patients in the endovascular than in the medical treatment arm (standard difference in means -0.21, 95% confidence interval (CI): -0.342 to -0.078, P = 0.002) despite a greater reduction in the mean number of antihypertensive drugs (standard difference in means -0.201, 95% CI: -0.302 to -0.1, P < 0.001). At variance, follow-up changes (from baseline) of systolic BP, serum creatinine, and incident cardiovascular event rates did not differ between treatment arms. Thus, patients with atherosclerotic renal artery stenosis receiving endovascular treatment required less anti-antihypertensive drugs at follow-up than those medically treated. Notwithstanding this, they evidenced a better control of diastolic BP.
authors.affiliation: Department of Medicine-DIMED, Internal Medicine 4, University of Padua, Padua, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Caielli
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Department of Medicine-DIMED, Internal Medicine 4, University of Padua, Padua, Italy.
authors.forename: Martino F
authors.initials: MF
authors.lastname: Pengo
authors.affiliation: Department of Medicine-DIMED, Internal Medicine 4, University of Padua, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rossitto
authors.affiliation: Department of Medicine-DIMED, Internal Medicine 4, University of Padua, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maiolino
authors.affiliation: Department of Medicine-DIMED, Internal Medicine 4, University of Padua, Padua, Italy.
authors.forename: Teresa Maria
authors.initials: TM
authors.lastname: Seccia
authors.affiliation: Department of Medicine-DIMED, Internal Medicine 4, University of Padua, Padua, Italy.
authors.forename: Lorenzo A
authors.initials: LA
authors.lastname: Calò
authors.affiliation: Department of Medicine-DIMED, Internal Medicine 4, University of Padua, Padua, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.affiliation: Department of Medicine-DIMED, Internal Medicine 4, University of Padua, Padua, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Rossi
mesh_terms: D050197:Atherosclerosis / Q000150:complications / Q000628:therapy*; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000628:therapy*; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012078:Renal Artery Obstruction / Q000209:etiology / Q000628:therapy*; D012307:Risk Factors
keywords: controlled randomized clinical trials; renal artery stenosis; renovascular hypertension; transluminal angioplasty