title: Plasma Renin Activity Predicts the Improvement in Resistant Hypertension after Percutaneous Transluminal Renal Artery Angioplasty.
abstract: Objective Percutaneous transluminal renal artery angioplasty (PTRA) has been recommended for the treatment of renovascular resistant hypertension. However, large randomized trials have reported that PTRA did not improve the outcomes compared with optimal medical therapy in patients with renal artery stenosis (RAS). It is important to identify patients with renovascular hypertension who are likely to respond to PTRA. We herein examined whether or not the plasma renin activity (PRA) could predict the improvement in resistant hypertension after PTRA for RAS. Methods and Results A total of 40 patients (mean age: 63±15 years) with unilateral RAS who received PTRA for resistant hypertension were enrolled in this study. Twenty-two (55%) patients experienced a significant reduction in their blood pressure while using few antihypertensive agents at the 3-month follow up. The median PRA was significantly higher in patients using few antihypertensive agents than in those using more [4.2 ng/mL/hr, interquartile range (IQR) 2.6-8.0 vs. 0.8 ng/mL/hr, IQR 0.4-1.7, p<0.001]. To predict the improvement in hypertension after PTRA, a receiver operating characteristic analysis determined the optimal cut-off value of PRA to be 2.4 ng/mL/hr. A multivariate logistic regression analysis showed that higher PRA (>2.4 ng/mL/hr) was an independent predictor of the improvement in hypertension after PTRA (odds ratio: 22.3, 95% confidence interval: 2.17 to 65.6, p<0.01). Conclusion These findings suggest that the evaluation of preoperative PRA may be a useful tool for predicting the improvement in resistant hypertension after PTRA for patients with RAS.
authors.affiliation: Department of Cardiology, Yamagata Prefectural Central Hospital, Japan.
authors.forename: Hyuma
authors.initials: H
authors.lastname: Daidoji
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tamada
authors.forename: Saya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Ken
authors.initials: K
authors.lastname: Watanabe
authors.forename: Taku
authors.initials: T
authors.lastname: Shikama
authors.forename: Yoku
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Kato
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Takahashi
authors.forename: Akio
authors.initials: A
authors.lastname: Fukui
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Matsui
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Yahagi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Goto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000601:surgery*; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012077:Renal Artery; D012078:Renal Artery Obstruction / Q000601:surgery*; D012083:Renin / Q000097:blood*
chemical_list: D000959:Antihypertensive Agents; D012083:Renin