Renal Artery Stenosis in Patients with Resistant Hypertension: Stent It or Not?
After three large neutral trials in which renal artery revascularization failed to reduce cardiovascular and renal morbidity and mortality, renal artery stenting became a therapeutic taboo. However, this is probably unjustified as these trials have important limitations and excluded patients most likely to benefit from revascularization. In particular, patients with severe hypertension were often excluded and resistant hypertension was either poorly described or not conform to the current definition. Effective pharmacological combination treatment can control blood pressure in most patients with renovascular hypertension. However, it may also induce further renal hypoperfusion and thus accelerate progressive loss of renal tissue. Furthermore, case reports of patients with resistant hypertension showing substantial blood pressure improvement after successful revascularization are published over again. To identify those patients who would definitely respond to renal artery stenting, properly designed randomized clinical trials are definitely needed.
Department of Nephrology & Hypertension, Universitair Ziekenhuis Brussel (VUB), Laarbeeklaan, 101,, Brussel, Belgium. Patricia.VanderNiepen@uzbrussel.be.
Patricia
P
Van der Niepen
Inserm, Centre d'Investigations Cliniques- Plurithématique 14-33, Inserm U1116, CHRU Nancy, Université de Lorraine, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Association Lorraine de Traitement de l'Insuffisance Rénale, Nancy, France.
Patrick
P
Rossignol
Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.|Nephrology Department, Grand Hôpital de Charleroi, Gilly, Belgium.
Jean-Philippe
JP
Lengelé
Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.|Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy.
Elena
E
Berra
Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Pantelis
P
Sarafidis
Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.|Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
Alexandre
A
Persu
D001794:Blood Pressure; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D012077:Renal Artery; D012078:Renal Artery Obstruction / Q000150:complications*; D015607:Stents; D016896:Treatment Outcome
Angioplasty and stenting; Blood pressure; Renal artery stenosis; Resistant hypertension