Comparison of the renal hyperemic effects of papaverine and dopamine in patients with renal artery stenosis

摘要

The purpose of this study was to assess the hyperemic effects of papaverine and dopamine in the renal microcirculation of hypertensive patients with renal artery stenosis (RAS). Although a poor correlation between angiographic lesion assessment and its hemodynamic significance is known, angiography is a major criterion for the decision of renal artery stenting. Assessment of the hyperemic translesional pressure gradient was recently shown to be conducive in identifying patients who may benefit from renal revascularization. The study included 14 patients (mean age, 66 +/- 11.2 years) with resistant hypertension and moderate RAS. Using a pressure-sensing catheter, systolic, diastolic, and mean translesional pressure gradients, and the distal pressure (Pd):aortic pressure (Pa) ratio (Pd/Pa) were analyzed at baseline and after administration of 40 mg papaverine and 50 mu g/kg dopamine. We did not observe significant changes in DG. Dopamine administration resulted in significant changes in systolic and mean translesional pressure gradients and Pd/Pa when compared with baseline (P < .05 for all). Changes in these parameters were caused by a decrease in systolic Pd in comparison with baseline conditions (119 +/- 34 mm Hg vs. 101 mm Hg; P < .05). Systolic Pd pressure after papaverine (104 mm Hg) did not change significantly. Systolic and diastolic Pa values did not differ from baseline after either dopamine or papaverine bolus administration. This study indicates that, compared with papaverine, the intrarenal bolus of dopamine in hypertensive patients with RAS remains a more powerful hyperemic agent. (C) 2015 American Society of Hypertension. All rights reserved.