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Published on: May 14, 2013
Correlation between hypertension and restenosis after endovascular therapy: a meta-analysis based on a derived cohort
Cheng Zhang1,2, Yarong Ma3, Qi Zhang4
1Department of General Surgery (Vascular Surgery), the Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
Insights
Hypertension does not significantly impact primary restenosis after stenting, according to this meta-analysis. Further research is needed due to study limitations and moderate evidence certainty.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Research
Background:
- Hypertension is a known risk factor for atherosclerosis and arterial narrowing.
- The association between hypertension and restenosis after endovascular treatment remains unclear.
Purpose of the Study:
- To investigate the relationship between hypertension and restenosis following endovascular treatment using a meta-analysis of randomized trials.
- To determine if hypertension influences the incidence of primary restenosis after stenting.
Main Methods:
- A systematic search of PubMed, EMBASE, and Cochrane Library databases was conducted for randomized trials published between January 1990 and January 2024.
- Data from 6 randomized controlled trials involving 5142 participants were analyzed using relative risks (RRs) and 95% confidence intervals.
- STATA 16.0 was used for pooled effect analysis, subgroup analysis, and meta-regression.
Main Results:
- The meta-analysis found no statistically significant relationship between hypertension and primary restenosis after stenting (RR = 1.05, 95% CI: 0.86-1.27, P = 0.66).
- Subgroup analyses by antiplatelet duration, device type, and vascular bed showed consistent results.
Conclusions:
- Hypertension does not appear to significantly affect primary restenosis rates after endovascular treatment.
- The certainty of evidence is moderate, and findings should be interpreted cautiously due to potential residual confounding and study limitations.
- Further robust prognostic studies are warranted to clarify the role of hypertension in restenosis.
Background:
Hypertension is believed to be strongly associated with narrowing of arteries or blockage due to the development of atherosclerosis. However, whether hypertension is linked to the occurrence of restenosis following percutaneous transluminal angioplasty (PTA) or the insertion of stents remains unclear.
Aims:
To explore the relationship between hypertension and restenosis after endovascular treatment, as indicated by existing randomized trials.
Methods:
From 01/1990 to 01/2024, the PubMed, EMBASE and Cochrane Library databases were searched for randomized trials. Trials meeting the eligibility and exclusion criteria were considered for inclusion. Two independent reviewers used a grading method to screen targeted studies. The pooled effects were assessed via relative risks (RRs) and 95% confidence intervals following evaluations for heterogeneity. The data from the combined effect extraction were analysed via STATA 16.0, subgroup analysis and meta-regression calculations. The incidence of restenosis after endovascular therapy of coronary or peripheral arteries in patients with or without hypertension was determined.
Results:
A total of 5142 individuals from 6 randomized controlled trials were included in this study. The results revealed that the relationship between hypertension and primary restenosis after stenting was not statistically significant (RR = 1.05, 95% CI: 0.86-1.27; P = 0.66).
Conclusions:
This meta-analysis of random trial cohorts revealed that hypertension had no significant effect on primary restenosis after endovascular treatment (RR = 1.05, 95% CI: 0.86-1.27), and the results were consistent across subgroups by antiplatelet duration, device type, and vascular bed; residual confounding could not be excluded. Using a GRADE framework adapted for prognostic factors, the overall certainty of evidence was moderate, and the results should be interpreted with caution. However, these findings are limited by the nonrandomized nature of the exposure, heterogeneity in endpoint definitions, and short follow-up, indicating a need for more robust prognostic studies.
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