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Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention?

Journal of Human Hypertension volume 18, pages 91–96 (2004)Cite this article

Abstract

The objective was to identify subgroups of patients with hypertension and atherosclerotic renal artery stenosis who may benefit from immediate intervention. In the DRASTIC study, patients with hypertension, significant atherosclerotic renal artery stenosis, and a normal or mildly impaired renal function were randomized between immediate balloon angioplasty (PTRA; n=56) and drug therapy followed by angioplasty after 3 months, if needed (Med-PTRA; n=50). In this secondary analysis of the data, changes in the renal function and blood pressure after 1 year were studied by analysis of covariance in the following subgroups: patients with positive captopril–renin challenge test, abnormal captopril renogram, recently developed hypertension, bilateral stenosis, and severe stenosis. We found a benefit of immediate angioplasty only for patients with bilateral stenosis. Their creatinine clearance had decreased (mean±s.d.: −4.2±13.5 ml/min) in the Med-PTRA group, whereas it had improved substantially (+10.0±15.7 ml/min) in the PTRA group (P=0.02). For patients with unilateral stenosis, the change in creatinine clearance did not differ between PTRA and Med-PTRA (+4.3±15.5 and +1.3±12.5 ml/min, respectively). The patients with bilateral stenosis also seemed to benefit most from immediate intervention with regard to blood pressure control. None of the other subgroups had a clear benefit of immediate intervention regarding renal function or blood pressure control. In conclusion, intervention should not be postponed in patients with bilateral stenosis, even if renal function is normal. Other hypertensive patients with atherosclerotic renal artery disease could initially well be treated by aggressive multidrug therapy alone unless hypertension persists or renal function deteriorates.

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References

  1. Kaplan NM . Renal vascular hypertension. In: Clinical Hypertension, 7th edn. Williams & Wilkins: Baltimore, 1998, pp 301–321.

    Google Scholar 

  2. Safian RD, Textor SC . Renal-artery stenosis. N Engl J Med 2001; 344: 431–442.

    Article  CAS  Google Scholar 

  3. Webster J et al. Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. J Hum Hypertens 1998; 12: 329–335.

    Article  CAS  Google Scholar 

  4. Plouin PF, Chatellier G, Darne B, Raynaud A . Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Hypertension 1998; 31: 823–829.

    Article  CAS  Google Scholar 

  5. van Jaarsveld BC et al. The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. N Engl J Med 2000; 342: 1007–1014.

    Article  CAS  Google Scholar 

  6. Ives NJ et al. Continuing uncertainty about the value of percutaneous revascularisation in atherosclerotic renovascular disease: a meta-analysis of randomised trials. Nephrol Dial Transplant 2003; 18: 298–304.

    Article  Google Scholar 

  7. Beutler JJ et al. Long-term effects of arterial stenting on kidney function for patients with ostial atherosclerotic renal artery stenosis and renal insufficiency. J Am Soc Nephrol 2001; 12: 1475–1481.

    CAS  PubMed  Google Scholar 

  8. Plouin PF, Rossignol P, Bobrie G . Atherosclerotic renal artery stenosis: to treat conservatively, to dilate, to stent, or to operate? J Am Soc Nephrol 2001; 12: 2190–2196.

    CAS  PubMed  Google Scholar 

  9. van de Ven PJ et al. Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial. Lancet 1999; 353: 282–286.

    Article  CAS  Google Scholar 

  10. Ramsay LE, Waller PC . Blood pressure response to percutaneous transluminal angioplasty for renovascular hypertension: an overview of published series. BMJ 1990; 300: 569–572.

    Article  CAS  Google Scholar 

  11. Isles CG, Robertson S, Hill D . Management of renovascular disease: a review of renal artery stenting in ten studies. QJM 1999; 92: 159–167.

    Article  CAS  Google Scholar 

  12. van Jaarsveld B et al. The Dutch Renal Artery Stenosis Intervention Cooperative (DRASTIC) Study: rationale, design and inclusion data. J Hypertens Suppl 1998; 16: S21–S27.

    CAS  Google Scholar 

  13. Cockcroft DW, Gault MH . Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.

    Article  CAS  Google Scholar 

  14. Pocock SJ, Hughes MD, Lee RJ . Statistical problems in the reporting of clinical trials. A survey of three medical journals. N Engl J Med 1987; 317: 426–432.

    Article  CAS  Google Scholar 

  15. Assmann SF, Pocock SJ, Enos LE, Kasten LE . Subgroup analysis and other (mis)uses of baseline data in clinical trials. Lancet 2000; 355: 1064–1069.

    Article  CAS  Google Scholar 

  16. Wilcox CS . Renal vascular disease. Functional testing: renin studies. Semin Nephrol 2000; 20: 432–436.

    CAS  PubMed  Google Scholar 

  17. Muller FB et al. The captopril test for identifying renovascular disease in hypertensive patients. Am J Med 1986; 80: 633–644.

    Article  CAS  Google Scholar 

  18. van Jaarsveld BC, Krijnen P . Renal vascular disease. Prospective studies of diagnosis and intervention: the Dutch experience. Semin Nephrol 2000; 20: 463–473.

    CAS  PubMed  Google Scholar 

  19. Taylor A . Renal vascular disease. Functional testing: ACEI renography. Semin Nephrol 2000; 20: 437–444.

    CAS  PubMed  Google Scholar 

  20. Pickering TG . Renovascular hypertension: etiology and pathophysiology. Semin Nucl Med 1989; 19: 79–88.

    Article  CAS  Google Scholar 

  21. Barri YM . Prediction of cure of hypertension in atherosclerotic renal artery stenosis. South Med J 1996; 89: 679–683.

    Article  CAS  Google Scholar 

  22. Connolly JO et al. Presentation, clinical features and outcome in different patterns of atherosclerotic renovascular disease. QJM 1994; 87: 413–421.

    CAS  PubMed  Google Scholar 

  23. Chábová V et al. Outcomes of atherosclerotic renal artery stenosis managed without revascularization. Mayo Clin Proc 2000; 75: 437–444.

    Article  Google Scholar 

  24. Frison L, Pocock SJ . Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design. Stat Med 1992; 11: 1685–1704.

    Article  CAS  Google Scholar 

  25. Bloch MJ, Pickering T . Renal vascular disease: medical management, angioplasty, and stenting. Semin Nephrol 2000; 20: 474–488.

    CAS  Google Scholar 

  26. Textor SC . Renal vascular disease. Epidemiology and clinical presentation. Semin Nephrol 2000; 20: 426–431.

    CAS  PubMed  Google Scholar 

  27. Sos TA . Angioplasty for the treatment of azotemia and renovascular hypertension in atherosclerotic renal artery disease. Circulation 1991; 83: I162–I166.

    Article  CAS  Google Scholar 

  28. Rimmer JM, Gennari FJ . Atherosclerotic renovascular disease and progressive renal failure. Ann Intern Med 1993; 118: 712–719.

    Article  CAS  Google Scholar 

  29. Harden PN et al. Effect of renal-artery stenting on progression of renovascular renal failure. Lancet 1997; 349: 1133–1136.

    Article  CAS  Google Scholar 

  30. Ramos F et al. Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis. Kidney Int 2003; 63: 276–282.

    Article  Google Scholar 

  31. Muray S et al. Rapid decline in renal function reflects reversibility and predicts the outcome after angioplasty in renal artery stenosis. Am J Kidney Dis 2002; 39: 60–66.

    Article  Google Scholar 

  32. Caps MT et al. Prospective study of atherosclerotic disease progression in the renal artery. Circulation 1998; 98: 2866–2872.

    Article  CAS  Google Scholar 

  33. Textor SC, Wilcox CS . Renal vascular disease. Ischemic nephropathy/azotemic renovascular disease. Semin Nephrol 2000; 20: 489–502.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    P Krijnen, E W Steyerberg & J D F Habbema

  2. Dianet Dialysis Centers, Utrecht, The Netherlands

    B C van Jaarsveld

  3. Department of Internal Medicine, University Medical Center St Radboud, Nijmegen, The Netherlands

    J Deinum

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  1. P Krijnen
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  2. B C van Jaarsveld
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  3. J Deinum
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  4. E W Steyerberg
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  5. J D F Habbema
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Correspondence to P Krijnen.

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Krijnen, P., van Jaarsveld, B., Deinum, J. et al. Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention?. J Hum Hypertens 18, 91–96 (2004). https://doi.org/10.1038/sj.jhh.1001641

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  • DOI: https://doi.org/10.1038/sj.jhh.1001641

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