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

P Krijnen1, B C van Jaarsveld, J Deinum

  • 1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. p.krijnen@erasmusmc.nl

Journal of Human Hypertension
|January 20, 2004
PubMed

Insights

Immediate angioplasty benefits patients with bilateral atherosclerotic renal artery stenosis. This intervention improved renal function and blood pressure, unlike drug therapy alone for this subgroup.

Area of Science:

  • Cardiology
  • Nephrology
  • Vascular Surgery

Background:

  • Hypertension and atherosclerotic renal artery stenosis (ARAS) affect many patients.
  • Identifying subgroups benefiting from immediate intervention is crucial for optimal outcomes.
  • The DRASTIC study previously randomized patients to immediate or delayed angioplasty.

Purpose of the Study:

  • To identify patient subgroups with hypertension and ARAS who benefit from immediate percutaneous transluminal renal angioplasty (PTRA).
  • To analyze the impact of immediate PTRA versus delayed PTRA on renal function and blood pressure in specific patient subgroups.

Main Methods:

  • Secondary analysis of the DRASTIC study data.
  • Patients with hypertension, significant ARAS, and normal/mildly impaired renal function were randomized.
  • Subgroups analyzed included positive captopril-renin test, abnormal renogram, recent hypertension, bilateral stenosis, and severe stenosis.
  • Renal function (creatinine clearance) and blood pressure changes were assessed after 1 year using analysis of covariance.

Main Results:

  • Immediate PTRA showed significant benefit only in patients with bilateral stenosis, improving creatinine clearance (+10.0 ml/min vs. -4.2 ml/min).
  • Patients with bilateral stenosis also experienced better blood pressure control with immediate PTRA.
  • No clear benefit of immediate intervention was observed for renal function or blood pressure in other analyzed subgroups (unilateral stenosis, positive captopril-renin test, etc.).

Conclusions:

  • Immediate intervention with PTRA is recommended for hypertensive patients with bilateral atherosclerotic renal artery stenosis, regardless of initial renal function.
  • Aggressive multidrug therapy may be sufficient initially for hypertensive patients with atherosclerotic renal artery disease and unilateral stenosis.
  • Delayed intervention or continued medical management is appropriate for patients without bilateral stenosis unless hypertension persists or renal function declines.

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