title: Anti-platelet and anti-hypertension medication use in patients with fibromuscular dysplasia: Results from the United States Registry for Fibromuscular Dysplasia.
abstract: Fibromuscular dysplasia (FMD), a non-inflammatory arterial disease, may lead to renovascular hypertension (HTN) and cerebrovascular disease. Little is known about medication use in FMD. Clinical features and medication use were reviewed in a national FMD registry (12 US sites). Medication usage was assessed in raw and adjusted analyses. Covariates included demographic characteristics, co-morbid conditions and vascular bed involvement. A total of 874 subjects (93.6% female) were included in the analysis. Mean age was 55.6±13.1 years, 74.5% had HTN, 25.4% had a history of transient ischemic attack or stroke, and 7.5% had a history of coronary artery disease (CAD). Renal and cerebrovascular arteries were affected in 70.4% and 74.7%, respectively. Anti-platelet agents were administered to 72.9% of patients. In multivariate analyses, factors associated with a greater likelihood of anti-platelet agent use were older age (OR=1.02 per year, p=0.005), CAD (OR=3.76, p=0.015), cerebrovascular artery FMD involvement in isolation (OR=2.31, p<0.0001) or a history of previous intervention for FMD (OR=1.52, p=0.036). A greater number of anti-HTN medications was evident in isolated renal versus isolated cerebrovascular FMD patients. Factors associated with a greater number of anti-HTN medications were older age (OR=1.03 per year, p<0.0001), history of HTN (OR=24.04, p<0.0001), history of CAD (OR=2.71, p=0.0008) and a history of a previous therapeutic procedure (OR=1.72, p=0.001). In conclusion, in FMD, medication use varies based on vascular bed involvement. Isolated renal FMD patients receive more anti-HTN agents and there is greater anti-platelet agent use among patients with cerebrovascular FMD. Further studies correlating medication use in FMD with clinically meaningful patient outcomes are necessary.
authors.affiliation: The Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA iweinberg@partners.org.
authors.forename: Ido
authors.initials: I
authors.lastname: Weinberg
authors.affiliation: Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Xiaokui
authors.initials: X
authors.lastname: Gu
authors.affiliation: Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
authors.affiliation: Cleveland Clinic Heart and Vascular Institute and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Soo E
authors.initials: SE
authors.lastname: Kim
authors.affiliation: North Central Heart Institute, Soux Falls, SD, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bacharach
authors.affiliation: University of South Carolina School of Medicine/Greenville, Greenville, SC, USA.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Gray
authors.affiliation: Baptist Cardiac and Vascular Institute, Miami, FL, USA.
authors.forename: Barry T
authors.initials: BT
authors.lastname: Katzen
authors.affiliation: Department of Radiology, Division of Vascular Interventional Radiology, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
authors.affiliation: Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA.
authors.forename: Yung-Wei
authors.initials: YW
authors.lastname: Chi
authors.affiliation: Cardiology Division, University of Colorado, Denver, CO, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Rogers
authors.affiliation: Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.
authors.forename: James
authors.initials: J
authors.lastname: Froehlich
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute and Marie-José and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Olin
authors.affiliation: Cleveland Clinic Heart and Vascular Institute and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
authors.affiliation: The Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects*; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006978:Hypertension, Renovascular; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012042:Registries / Q000706:statistics & numerical data; D012077:Renal Artery / Q000187:drug effects; D012078:Renal Artery Obstruction / Q000188:drug therapy*; D014481:United States
chemical_list: D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors
keywords: FMD; anti-platelet; fibromuscular dysplasia; hypertension; medication