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[Renovascular hypertension: comparison between transluminal dilatation and surgical procedures]
Insights
Percutaneous transluminal dilatation (PTD) and surgery offer comparable blood pressure reduction for renovascular hypertension. Surgery is preferred for complex cases, while PTD is favorable for others, improving outcomes for patients with atherosclerotic stenosis and fibromuscular dysplasia.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Renovascular hypertension significantly impacts cardiovascular health.
- Treatment decisions for renovascular hypertension depend on stenosis etiology (atherosclerotic stenosis vs. fibromuscular dysplasia) and complexity.
- Both surgical intervention and percutaneous transluminal dilatation (PTD) are established treatment modalities.
Purpose of the Study:
- To compare the efficacy of PTD versus surgical procedures in managing renovascular hypertension.
- To analyze treatment outcomes based on the underlying cause of renal artery stenosis (atherosclerotic stenosis and fibromuscular dysplasia).
Main Methods:
- A comparative study involving 96 patients with renovascular hypertension.
- Patients were divided into two groups: surgical procedures (n=51) and PTD (n=45).
- Group-specific analysis was performed for atherosclerotic stenosis (ASS) and fibromuscular dysplasia (FMD) subgroups, assessing demographic data, hypertension duration, pretreatment blood pressure, and post-treatment blood pressure over a mean 2.6-year follow-up.
Main Results:
- Both surgical and PTD groups demonstrated comparable reductions in blood pressure post-intervention.
- Surgical patients had a shorter mean duration of hypertension and higher pretreatment blood pressure compared to PTD patients.
- Post-treatment blood pressure in the surgery group was 147/90 mm Hg (ASS) and 139/87 mm Hg (FMD); in the PTD group, it was 145/90 mm Hg (ASS) and 132/84 mm Hg (FMD).
Conclusions:
- PTD and surgical interventions yield comparable blood pressure-lowering effects in renovascular hypertension.
- Surgical intervention is recommended for cases with lengthy stenosis, involvement of primary renal artery branches, or aneurysms.
- PTD is a favorable option for the remaining cases of renovascular hypertension, offering effective management for both atherosclerotic stenosis and fibromuscular dysplasia.
Abstract:
Percutaneous transluminal dilatation (PTD; n = 45) was compared with surgical procedures (n = 51) in 96 patients with renovascular hypertension. Since cases with atherosclerotic stenosis (ASS) are known to show a different response to surgery than those with fibromuscular dysplasia (FMD), group-specific analysis was performed. In their two subgroups (ASS and FMD) both surgical and dilated patients showed comparable mean age and sex distribution and serum creatinine. However, differences were observed in mean duration of hypertension and in pretreatment blood pressure values: surgical patients with ASS and FMD showed a lower mean duration of hypertension (operation: ASS 3.2, FMD 1.9 years; PTD: ASS 5.1, FMD 3.4 years) and higher mean blood pressure values (surgery: ASS 207/121, FMD 209/126 mm Hg; PTD: ASS 199/115, FMD 175/108 mm Hg). After a mean observation period of 2.6 years mean blood pressure fell in the surgery group to 147/90 mm Hg in the 26 cases with ASS, and to 139/87 mm Hg in the 25 patients with FMD. In dilated cases respective blood pressure values were 145/90 mm Hg (ASS, n = 17) and 132/84 mm Hg (FMD, n = 11). These results show a comparable blood pressure lowering effect for surgery and dilatation in renovascular hypertension. In cases with lengthy stenosis or involvement of primary branches of the renal artery and in those with aortic or poststenotic renal aneurysm a surgical technique should be performed, whereas in the remaining cases PTD represents a favourable procedure.