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Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis

Journal of Human Hypertension volume 19, pages 761–767 (2005)Cite this article

Abstract

Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but long-time follow-up is lacking. Retrospective follow-up for 7.0±4.7 years of 69 consecutive patients (age 44±13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge (from 174±33/100±13 to 138±19/80±15 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.0±4.7 years (140±25/83±12 mmHg; P<0.0001). Serum-creatinine had decreased both at 1 year (from 84±28 to 75±13 μmol/l; P=0.0030) and last follow-up (75±16 μmol/l; P=0.0017). The number of antihypertensive drugs decreased (from 2.3±1.2 before PTRA to 1.4±1.3 at discharge and at 1 month; P<0.0001, and 1.6±1.5 at last follow-up; P=0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43±29 vs 20±41 mmHg; P=0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.9±7.7 vs 1.8±4.1 years; P=0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.

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Acknowledgements

This study was supported by grants from the Ernhold Lundström Foundation, Research Funds at University Hospital MAS, the Albert Påhlsson Foundation, and the Hulda Ahlmroth Foundation. We thank biostatistician Nuray Güner at Region Skåne Competence Centre for Clinical Research for expert statistical advice.

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  1. Department of Vascular Diseases and Endovascular Reconstructions, University of Lund, University Hospital, Malmö, Sweden

    A Alhadad, I Mattiasson, K Ivancev, A Gottsäter & B Lindblad

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  1. A Alhadad
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Correspondence to A Alhadad.

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Alhadad, A., Mattiasson, I., Ivancev, K. et al. Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis. J Hum Hypertens 19, 761–767 (2005). https://doi.org/10.1038/sj.jhh.1001893

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