Does percutaneous transluminal renal artery angioplasty improve blood pressure control and renal function in patients with atherosclerotic renal artery stenosis?

摘要

BACKGROUND: Percutaneous angioplasty (PTA) and stenting is an established procedure for the treatment of hypertension caused by atherosclerotic renal artery stenosis. However recently, the decision whether or notto perform this procedure has raised considerable debate. OBJECTIVES: To examine the association between the basic clinical and radiological characteristics of candidates for renal artery PTA and the clinical outcome of the procedure in terms of improvement of blood pressure control and renal function. METHODS: We conducted a retrospective cohort study of all patients who underwent percutaneous transluminal renal artery angioplasty (PTRA) and stent implantation in a tertiary medical center during the period 2000-2007. The clinical and radiological data were extracted from the medical file of each patient. Blood pressure measurements and creatinine level were recorded before the procedure and 1 month, 6 months, 12 months and 18 months after PTRA. RESULTS: Thirty-two patients were included in the final statistical analysis. The mean age of the study population was 66.6 +/- 8.8 years old and 75% were men. There was a significant reduction in both systolic and diastolic blood pressure 1 month after the procedure: 160.5 +/- 24.7 vs. 141.8 +/- 23.6 mmHg and 83.8 +/- 12.9 vs. 68.8 +/- 11.8 mmHg respectively (P < 0.001). The reduction in blood pressure was constant throughout the follow-up period and was evident 18 months after the procedure: 160.5 +/- 24.7 vs. 135.0 +/- 35.1 mmHg and 83.8 +/- 12.9 vs. 71.3 +/- 16.5 mmHg respectively (P < 0.001). However, no improvement in renal function was observed at any time during the follow-up period. We could not demonstrate an association between clinical or radiological features and the clinical outcome after PTRA. CONCLUSIONS: Our findings show that PTRA can be considered an effective procedure for improving blood pressure control in patients with atherosclerotic renal artery stenosis (ARAS) and resistant hypertension. This research, together with previous studies, strengthens the knowledge that the decline in glomerular filtration rate seen in many patients with ARAS is non-reversible and is not improved by PTRA.