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Survival associated with renovascular disease in Glasgow and Newcastle: a collaborative study
1MRC Blood Pressure Unit, Western Infirmary, Glasgow.
Insights
Patients with renovascular disease have reduced survival rates. Age, smoking, and atherosclerosis significantly impact outcomes, but surgical intervention benefits remain unproven due to non-randomized data.
Area of Science:
- Cardiology
- Nephrology
- Epidemiology
Background:
- Renovascular disease significantly impacts patient survival.
- Previous studies have not definitively established prognostic factors or optimal treatment strategies.
Purpose of the Study:
- To retrospectively analyze factors influencing outcomes in patients with hypertension and renovascular disease.
- To compare survival rates with general population and essential hypertensive cohorts.
- To evaluate the impact of surgical intervention versus medical management.
Main Methods:
- Retrospective analysis of data from 121 patients diagnosed between 1975-1982.
- Calculation of five and ten-year survival rates.
- Multivariate analysis to identify independent predictors of outcome.
Main Results:
- Five and ten-year survival rates were 83% and 67%, respectively.
- Age, cigarette smoking, and atheromatous disease were significant independent predictors of mortality.
- Surgical intervention showed a trend towards improved ten-year survival (71% vs. 62%), but this was not statistically significant (p=0.19).
Conclusions:
- Survival in renovascular disease patients is significantly lower than in matched controls.
- Age, smoking, and atherosclerosis are key determinants of prognosis.
- Further randomized trials are needed to ascertain the efficacy of surgical intervention.
Abstract:
Data from 121 consecutive patients with hypertension and renovascular disease, first diagnosed between 1975 and 1982 in Glasgow and Newcastle, were analysed retrospectively to determine the factors which influenced their outcome. Thirty-six patients died between the data of arteriography and 1st January 1987, giving five and ten year survival rates of 83% and 67%. Survival was greatly reduced in comparison with that of age-sex-matched controls in the general population of the West of Scotland, and was also less than that of essential hypertensives matched for age, sex, initial diastolic blood pressure and smoking habit who had attended the Glasgow Blood Pressure Clinic during the same period. Multivariate analysis showed that age, cigarette smoking and presence of atheromatous disease were significantly and independently related to outcome among the patients with renovascular disease, whereas male sex, centre of origin, severity of hypertension when first seen, initial renal function and presence of bilateral disease were not. Despite a trend towards benefit from surgical intervention (ten year survival in medical group 62%, in surgical group 71%; p = 0.19) our data do not prove that intervention is better than medical treatment, largely because the decision on intervention was not randomised. A prospective trial would be required to answer this important question.