Use of Endovascular Stents in Atherosclerotic Renovascular Stenosis: Blood Pressure and Renal Function Changes in Hypertensive Patients

Predictors of clinical outcome after stent placement in atherosclerotic renal artery stenosis: a systematic review and meta-analysis of prospective studies

OBJECTIVE

To determine clinical predictors for blood pressure and/or renal function improvement after renal artery stent placement in atherosclerotic renal artery stenosis (ARAS).

METHODS

We searched PubMed, EMBASE and Cochrane databases for prospective studies investigating clinical predictive variables for renal function and/or blood pressure improvement after stent placement in ARAS. Eleven studies (1552 participants) were selected for our systematic review and meta-analysis. Meta-regression analysis was performed to investigate heterogeneity and to determine independent predictors for the outcome variables. Bias was evaluated by use of the Cochrane risk of bias tool.

RESULTS

Multivariate meta-regression analysis showed no predictors for renal function improvement. High baseline diastolic blood pressure (DBP) and pulse pressure were significantly associated with the decrease in blood pressure after intervention. These results were consistent with the predictors reported by the individual studies. Meta-analysis showed a nonsignificant decline in serum creatinine of 4.7 μmol/l [95% confidence interval (Cl) -13.8 to 4.5]. Overall, systolic blood pressure (SBP) fell by 19.2 mmHg (95% Cl -22.7 to -15.7) and DBP decreased 8.9 mmHg (95% Cl -10.8 to -7.0). Risk of bias was present in the majority of the studies.

CONCLUSIONS

The present review did not find a clinical characteristic that reliably predicts renal function outcome. High baseline pulse pressure predicted a smaller decrease in SBP after intervention and the best clinical predictor for a larger DBP reduction was a high pretreatment DBP.

Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the one-year outcome

OBJECTIVE

The study aimed to determine the potential interrelations between left ventricle mass (LVM), LV diastolic function, systolic blood pressure (SBP) and diastolic blood pressure (DBP) and cardiovascular events in patients undergoing renal artery stenting [corrected] (RAS).

METHODS

Prior to RAS, 3 and 12 months afterward, the change in LVM, left ventricular mass index (LVMI), diastolic function (E/A ratio, E' wave velocity, isovolumetric relaxation time [IVRT], E/E' ratio) on echocardiography and change in SBP and DBP on 24-hour monitoring were assessed in 84 patients, aged 63.7 ± 10 years, who underwent RAS for renal artery stenosis > 60%.

RESULTS

During 12 months, 12 (14.3%) cardiovascular (CV) events (five deaths) occurred. At 1 year, the mean LVM decreased from 179 ± 49 g to 141 ± 31 g (P < .001), LVMI in men decreased from 100 ± 20 g/m(2) to 79 ± 18 g/m(2) (P < .001), and the LVMI in women decreased from 96 ± 18 g/m(2) to 80 ± 17 g/m(2) (P < .001). No improvement in diastolic function parameters was seen. The mean SBP and DBP decreased from 133.5 ± 16.9 mm Hg to 127.9 ± 13.2 mm Hg (P = .007) and from 75.4 ± 10.2 mm Hg to 73.1 ± 8.8 mm Hg (P = .035), respectively. On multivariate logistic regression analysis, coronary artery disease (CAD) severity (relative risk [RR], 1.27; P = .023), smoking (RR, 1.29; P = .016), and baseline LVM (RR, 1.21; P = .07) were found as independent CV event risk factors. The independent factors associated with SBP and DBP improvement were grade of renal stenosis (RR, 1.28; P = .006), bilateral RAS procedure (RR, 1.17; P = .07), and baseline DBP value (RR, 1.74; P < .001). LVM reduction was associated with higher baseline ejection fraction (RR, 1.53; P < .001) and baseline LVM (RR, 1.7; P < 0.001). SBP and DBP value changes were independent of LVM change (r = 0.031; P = .796 and r = 0.098; P = .413, respectively).

CONCLUSIONS

RAS induced LVM and LVMI reduction, which is independent of the change in blood pressure. Baseline LVM is associated with higher CV event risk following RAS.