title: Effects of Percutaneous Transluminal Renal Angioplasty on Office and Home Blood Pressure and Home Blood Pressure Variability in Hypertensive Patients With Renal Artery Stenosis.
abstract: This study included 126 hypertensive patients with renal artery stenosis (mean age, 63 years; 22.2% fibromuscular dysplasia [FMD]) and investigated the effects of percutaneous transluminal renal angioplasty on office and home blood pressure (BP), and BP variability estimates derived from home BP, both at baseline and up to 12 months after angioplasty. Home BP was measured for 7 consecutive days, and the threshold defining uncontrolled home BP was ≥135/85 mm Hg. In both the FMD and atherosclerotic stenosis (ARAS) groups, office and home BP decreased significantly after angioplasty (all P<0.01), but the decrease in morning home (-22±19 versus -10±20 mm Hg; P<0.01) but not in office (-32±24 versus -23±28 mm Hg; P=0.11) systolic BP at 12 months was significantly greater in FMD. In both groups, all morning BP variability indices except the coefficient of variation in ARAS decreased significantly after revascularization (all P<0.05 by repeated-measures ANOVA). The decrease in all morning systolic BP variability estimates was greater for FMD than for ARAS (all P<0.05 by 2-way repeated-measures ANOVA), with the exception of variability independent of the mean (P=0.11). The prevalence of uncontrolled home BP was 77.0% at baseline and 38.9% after revascularization. Duration of hypertension (odds ratio, 1.48), ARAS (odds ratio, 3.18), and the presence of proteinuria (odds ratio, 2.10) were independent predictors of uncontrolled home BP after revascularization (all P<0.05). In conclusion, renal angioplasty produced a greater decrease of morning home systolic BP in FMD; however, in both groups, it decreased BP variability irrespective of BP response. Measurement of home BP seems to be important for treatment success, especially in ARAS.
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.). iwashima@hsp.ncvc.go.jp.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Iwashima
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kusunoki
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Shin-Ichiro
authors.initials: SI
authors.lastname: Hayashi
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Kishida
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Fumiki
authors.initials: F
authors.lastname: Yoshihara
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Satoko
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Kei
authors.initials: K
authors.lastname: Kamide
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Takeshi
authors.initials: T
authors.lastname: Horio
authors.affiliation: From the Division of Hypertension and Nephrology (Y.I., H.K., S.-i.H., M.K., F.Y., S.N., Y.K.), and Department of Radiology (T.F.), Department of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Health Science, Osaka University Graduate School of Medicine, Japan (K.K.); Department of Internal Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan (T.H.); and Department of Medical Technology, Teikyo University Fukuoka, Japan (Y.K.).
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kawano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult
keywords: angioplasty; blood pressure; fibromuscular dysplasia; hypertension, renovascular; renal artery obstruction