TY - JOUR
T1 - Renal Artery Stenting in Consecutive High-Risk Patients With Atherosclerotic Renovascular Disease
T2 - A Prospective 2-Center Cohort Study
AU - Reinhard, Mark
AU - Schousboe, Karoline
AU - Andersen, Ulrik B
AU - Buus, Niels Henrik
AU - Rantanen, Jesper Moesgaard
AU - Bech, Jesper Nørgaard
AU - Mafi, Hossein Mohit
AU - Langfeldt, Sten
AU - Bharadwaz, Arindam
AU - Hørlyck, Arne
AU - Jensen, Mogens Kærsgaard
AU - Jeppesen, Jørgen
AU - Olsen, Michael Hecht
AU - Jacobsen, Ib Abildgaard
AU - Bibby, Bo Martin
AU - Christensen, Kent Lodberg
PY - 2022/4/5
Y1 - 2022/4/5
N2 - Background The aim of this study was to prospectively evaluate the effects of renal artery stenting in consecutive patients with severe atherosclerotic renal artery stenosis and high-risk clinical presentations as defined in a national protocol developed in 2015. Methods and Results Since the protocol was initiated, 102 patients have been referred for revascularization according to the following high-risk criteria: severe renal artery stenosis (≥70%) with true resistant hypertension, rapidly declining kidney function, or recurrent heart failure/sudden pulmonary edema. At baseline, the mean 24-hour ambulatory systolic blood pressure was 166.2 mm Hg (95% CI, 162.0-170.4), the defined daily dose of antihypertensive medication was 6.5 (95% CI, 5.8-7.3), and the estimated glomerular filtration rate was 41.1 mL/min per 1.73m2 (95% CI, 36.6-45.6). In 96 patients with available 3-month follow-up data, mean 24-hour ambulatory systolic blood pressure decreased by 19.6 mm Hg (95% CI, 15.4-23.8; P<0.001), the defined daily dose of antihypertensive medication was reduced by 52% (95% CI, 41%-62%; P<0.001), and estimated glomerular filtration rate increased by 7.8 mL/min per 1.73m2 (95% CI, 4.5-11.1; P<0.001). All changes persisted after 24 month follow-up. Among 17 patients with a history of hospitalization for acute decompensated heart failure, 14 patients had no new episodes after successful revascularization. Conclusions In this prospective cohort study, we observed a reduction in blood pressure and antihypertensive medication, an increase in estimated glomerular filtration rate, and a decrease in new hospital admissions attributable to heart failure/sudden pulmonary edema after renal artery stenting. Registration URL: https://clinicaltrials.gov. Identifier: NCT02770066.
AB - Background The aim of this study was to prospectively evaluate the effects of renal artery stenting in consecutive patients with severe atherosclerotic renal artery stenosis and high-risk clinical presentations as defined in a national protocol developed in 2015. Methods and Results Since the protocol was initiated, 102 patients have been referred for revascularization according to the following high-risk criteria: severe renal artery stenosis (≥70%) with true resistant hypertension, rapidly declining kidney function, or recurrent heart failure/sudden pulmonary edema. At baseline, the mean 24-hour ambulatory systolic blood pressure was 166.2 mm Hg (95% CI, 162.0-170.4), the defined daily dose of antihypertensive medication was 6.5 (95% CI, 5.8-7.3), and the estimated glomerular filtration rate was 41.1 mL/min per 1.73m2 (95% CI, 36.6-45.6). In 96 patients with available 3-month follow-up data, mean 24-hour ambulatory systolic blood pressure decreased by 19.6 mm Hg (95% CI, 15.4-23.8; P<0.001), the defined daily dose of antihypertensive medication was reduced by 52% (95% CI, 41%-62%; P<0.001), and estimated glomerular filtration rate increased by 7.8 mL/min per 1.73m2 (95% CI, 4.5-11.1; P<0.001). All changes persisted after 24 month follow-up. Among 17 patients with a history of hospitalization for acute decompensated heart failure, 14 patients had no new episodes after successful revascularization. Conclusions In this prospective cohort study, we observed a reduction in blood pressure and antihypertensive medication, an increase in estimated glomerular filtration rate, and a decrease in new hospital admissions attributable to heart failure/sudden pulmonary edema after renal artery stenting. Registration URL: https://clinicaltrials.gov. Identifier: NCT02770066.
KW - Angioplasty, Balloon/adverse effects
KW - Antihypertensive Agents/pharmacology
KW - Blood Pressure
KW - Cohort Studies
KW - Glomerular Filtration Rate
KW - Humans
KW - Prospective Studies
KW - Renal Artery
KW - Renal Artery Obstruction/complications
KW - Stents
KW - Treatment Outcome
KW - flash pulmonary edema
KW - atherosclerotic renal artery stenosis
KW - resistant hypertension
KW - rapid loss of kidney function
KW - renal revascularization
KW - atherosclerotic renovascular disease
UR - http://www.scopus.com/inward/record.url?scp=85128245135&partnerID=8YFLogxK
U2 - 10.1161/JAHA.121.024421
DO - 10.1161/JAHA.121.024421
M3 - Journal article
C2 - 35322677
SN - 2047-9980
VL - 11
SP - 1
EP - 20
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 7
M1 - e024421
ER -