Cigarette smoking and atherosclerotic renal artery stenosis

The charts of all patients over 30 for whom an adequate smoking history was available and an arteriogram or DIVA was done, specifically looking for renal artery stenosis, were reviewed to evaluate the role of cigarette smoking in contributing to the development of atherosclerotic renovascular hypertension. A patient was considered to be a "case" if the angiographic study demonstrated a typical stenotic lesion and a procedure (surgery or angioplasty) cured or definitely improved the patient's hypertension. If the study was negative, the patient was considered to be a "control." Twenty-one cases and 27 controls were found. The cases were older (57.5 vs. 49.25 years) and all were white (100% vs. 89%). Both groups had severe hypertension, but the cases had disproportionate systolic elevations (premedication BP 226 +/- 32/126 +/- 24 mmHg vs. 193 +/- 30/121 +/- 24 mmHg) and did not respond as well to drug treatment (180 +/- 30/99 +/- 6 vs. 139/85 +/- 10 mmHg) as the controls. There were significantly more smokers (19/21 vs. 16/27, p less than 0.04; odds ratio 6.53) among the cases, and 17 of the 19 were heavy smokers (greater than 25 pack-years). We conclude that cigarette smoking may contribute to the development of atherosclerotic renovascular hypertension.