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Wang S, Zhang S, Li Y, Ma N, Li M, Ai H, Zhu H, Ren J, Li Y, Li P. Correlation of renal cortical blood perfusion and BP response after renal artery stenting. Front Cardiovasc Med 2022; 9:939519. [PMID: 36262208 PMCID: PMC9573998 DOI: 10.3389/fcvm.2022.939519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to observe the correlation between renal cortical blood perfusion (CBP) parameters and BP response in patients with severe renal artery stenosis (RAS) who underwent stenting. Methods This was a single-center retrospective cohort study. A total of 164 patients with unilateral severe RAS after successful percutaneous transluminal renal artery stenting in Beijing Hospital from October 2017 to December 2020 were included. According to the results of BP evaluated at 12 months, all patients were divided into the BP response group (n = 98) and BP nonresponse group (n = 66). The baseline clinical and imaging characteristics and follow-up data about 24 h ABPM and CBP were recorded and analyzed. Pearson correlation analysis was used to evaluate the relationship between CBP parameters and 24 h average SBP. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for BP response. Results Among 164 patients with severe RAS, there were 100 males (61.0%), aged 37–75 years, with an average of 56.8 ± 18.4 years, and average artery stenosis of 84.0 ± 12.5%. The BP nonresponse patients had a longer duration of hypertension, more current smoking subjects and diabetic patients, lower eGFR, increased number of hypertensive agents, and rate of insulin compared with the BP response group (P < 0.05). After PTRAS, patients in the BP response group were associated with significantly lower BP and improved CPB, characterized by increased levels of maximum intensity (IMAX), area under ascending curve (AUC1), area under the descending curve (AUC2), shortened rising time (RT), mean transit time (mTT), and prolonged time to peak intensity (TTP; P < 0.05). However, the BP nonresponse group was only associated with significantly reduced RT (P < 0.05) compared with baseline data. During an average follow-up of 11.5 ± 1.7 months, the BP response group was associated with significantly lower levels of SBP, DBP, 24 h average SBP, and 24 h average DBP compared with the nonresponse group (P < 0.05). Pearson correlation analysis showed that the the pre-operative CBP parameters, including IMAX (r = 0.317), RT (r = 0.249), AUC1 (r = 0.614), AUC2 (r = 0.558), and postoperative CBP parameters, including RT (r = 0.283), AUC1 (r = 0.659), and AUC2 (r = 0.674) were significantly positively correlated with the 24 h average SBP, while the postoperative TTP (r = −0.413) and mTT (r = −0.472) were negatively correlated with 24 h average SBP (P < 0.05). Multivariate Logistic regression analysis found that diabetes (OR = 1.294), NT-proBNP (OR = 1.395), number of antihypertensive agents (OR = 2.135), pre-operation IMAX (OR = 1.534), post-operation AUC2 (OR = 2.417), and baseline dDBP (OR = 2.038) were related factors for BP response (all P < 0.05). Conclusion Patients in the BP nonresponse group often have diabetes, a longer duration of hypertension, significantly reduced glomerular filtration rate, and heavier renal artery stenosis. CBP parameters are closely related to 24 h average SBP, and pre-operation IMAX and post-operation AUC2 are markers for a positive BP response.
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Affiliation(s)
- Siyu Wang
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Beijing, China,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sijie Zhang
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Beijing, China,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China,Graduate School of Peking Union Medical College, Beijing, China
| | - Yan Li
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Beijing, China,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Ma
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Beijing, China,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengpu Li
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Beijing, China,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hu Ai
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Hui Zhu
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China,Department of Nuclear Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Junhong Ren
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Beijing, China,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China,*Correspondence: Junhong Ren
| | - Yongjun Li
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China,Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Peng Li
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
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Narita K, Hoshide S, Kario K. Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour Blood Pressure Profiles. J Am Heart Assoc 2022; 11:e025901. [PMID: 35975740 PMCID: PMC9496410 DOI: 10.1161/jaha.122.025901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Keisuke Narita
- Division of Cardiovascular Medicine, Department of Internal Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Internal Medicine Jichi Medical University School of Medicine Tochigi Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine Jichi Medical University School of Medicine Tochigi Japan
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Bhalla V, Textor SC, Beckman JA, Casanegra AI, Cooper CJ, Kim ESH, Luther JM, Misra S, Oderich GS. Revascularization for Renovascular Disease: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e128-e143. [PMID: 35708012 DOI: 10.1161/hyp.0000000000000217] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renovascular disease is a major causal factor for secondary hypertension and renal ischemic disease. However, several prospective, randomized trials for atherosclerotic disease failed to demonstrate that renal revascularization is more effective than medical therapy for most patients. These results have greatly reduced the generalized diagnostic workup and use of renal revascularization. Most guidelines and review articles emphasize the limited average improvement and fail to identify those clinical populations that do benefit from revascularization. On the basis of the clinical experience of hypertension centers, specialists have continued selective revascularization, albeit without a summary statement by a major, multidisciplinary, national organization that identifies specific populations that may benefit. In this scientific statement for health care professionals and the public-at-large, we review the strengths and weaknesses of randomized trials in revascularization and highlight (1) when referral for consideration of diagnostic workup and therapy may be warranted, (2) the evidence/rationale for these selective scenarios, (3) interventional and surgical techniques for effective revascularization, and (4) areas of research with unmet need.
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4
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Hengel FE, Sommer C, Wenzel U. [Arterial Hypertension]. Dtsch Med Wochenschr 2022; 147:414-428. [PMID: 35345049 DOI: 10.1055/a-1577-8663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Arterial hypertension affects about one third of the German population with a prevalence increasing with age up to 60 %. Globally, more than a quarter gedoppelt of the population are considered hypertensive, resulting in a total of more than one billion people. Not only due to such high prevalence, but also because of its multiple cardiovascular, renal, ocular, and cognitive complications, arterial hypertension is a leading contributor to the global burden of disease and responsible for up to 10 million deaths worldwide. Contrary to the great importance of arterial hypertension resulting from such high prevalence and immense impact on health worldwide, awareness of disease is low in affected people. Less than every second patient knows about his or her disease status and less than 40 % of patients in Europe show adequate blood pressure control with a treatment target of < 140/90 mmHg despite antihypertensive treatment. This overview of arterial hypertension, its etiology, diagnostic tools, and therapeutic options aims to improve the understanding of arterial hypertension and to facilitate the diagnostic and therapeutic approach, eventually resulting in a better and more successful handling of patients with arterial hypertension.
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Badacz R, Kabłak-Ziembicka A, Rosławiecka A, Rzeźnik D, Baran J, Trystuła M, Legutko J, Przewłocki T. The Maintained Glycemic Target Goal and Renal Function Are Associated with Cardiovascular and Renal Outcomes in Diabetic Patients Following Stent-Supported Angioplasty for Renovascular Atherosclerotic Disease. J Pers Med 2022; 12:jpm12040537. [PMID: 35455652 PMCID: PMC9028557 DOI: 10.3390/jpm12040537] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) constitute a large proportion of patients with atherosclerotic renal artery stenosis (ARAS). However, the mechanism of impaired renal function and hypertension in this subset of patients is multifactorial. We aimed to investigate whether, in diabetic patients, renal function (RF), systolic (SBP) and diastolic blood pressure (DBP) values following stent-supported angioplasty (PTA) for ARAS have an impact on cardiovascular and renal outcomes. Methods: The study group included 93 patients with T2DM and resistant hypertension who underwent PTA for ARAS. The pre- and post-procedure (6 to 12, and 24 months) values of SBP, DBP, eGFR and glycaemia were obtained. The prospective follow-up of median 44 months was performed for combined outcome: major cardiac and cerebral events (MACCE) and progression to renal replacement therapy (RRT). Results: MACCE-RRT occurred in 46 (49.5%) patients, with higher incidence in patients with higher values of SBP (147.8 ± 25.8 vs. 136.7 ± 15.8 mmHg, p = 0.006), DBP (80.8 ± 13.3 vs. 74.4 ± 12.3 mmHg, p = 0.009), chronic kidney disease in stages 3B to 5 (p = 0.029) and those who have not obtained target glycemic goals compared to well-maintained T2DM (p = 0.007) at 24-months. On multivariate Cox analysis, well-maintained T2DM targets [Hazard Ratio (HR):0.27; 95% Confidence Interval (CI):0.13−0.57; p < 0.001], eGFR below 45 mL/min/m2 (HR: 2.20; 95%CI: 1.20−4.04; p = 0.011), previous stroke (HR:2.52; 95%CI:1.19−5.34; p = 0.015) retained their associations with MACCE-RRT, while BP values were not associated with the outcome. Conclusions: The post-procedural RF, maintained glycemic target goal and previous stroke are vital for the outcome in patients undergoing PTA for renovascular disease in diabetic patients.
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Affiliation(s)
- Rafał Badacz
- Department of Interventional Cardiology, Institute of Cardiology, Medical College, Jagiellonian University, 31-008 Krakow, Poland; (R.B.); (D.R.); (J.B.); (J.L.)
- Department of Interventional Cardiology, The John Paul II Hospital, 31-202 Krakow, Poland; (A.R.); (T.P.)
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Medical College, Jagiellonian University, 31-008 Krakow, Poland; (R.B.); (D.R.); (J.B.); (J.L.)
- Noninvasive Cardiovascular Laboratory, The John Paul II Hospital, 31-202 Krakow, Poland
- Correspondence:
| | - Agnieszka Rosławiecka
- Department of Interventional Cardiology, The John Paul II Hospital, 31-202 Krakow, Poland; (A.R.); (T.P.)
| | - Daniel Rzeźnik
- Department of Interventional Cardiology, Institute of Cardiology, Medical College, Jagiellonian University, 31-008 Krakow, Poland; (R.B.); (D.R.); (J.B.); (J.L.)
- Department of Interventional Cardiology, The John Paul II Hospital, 31-202 Krakow, Poland; (A.R.); (T.P.)
| | - Jakub Baran
- Department of Interventional Cardiology, Institute of Cardiology, Medical College, Jagiellonian University, 31-008 Krakow, Poland; (R.B.); (D.R.); (J.B.); (J.L.)
- Department of Interventional Cardiology, The John Paul II Hospital, 31-202 Krakow, Poland; (A.R.); (T.P.)
| | - Mariusz Trystuła
- Department of Vascular and Endovascular Surgery, John Paul II Hospital, 31-202 Krakow, Poland;
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Medical College, Jagiellonian University, 31-008 Krakow, Poland; (R.B.); (D.R.); (J.B.); (J.L.)
- Department of Interventional Cardiology, The John Paul II Hospital, 31-202 Krakow, Poland; (A.R.); (T.P.)
| | - Tadeusz Przewłocki
- Department of Interventional Cardiology, The John Paul II Hospital, 31-202 Krakow, Poland; (A.R.); (T.P.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Medical College, Jagiellonian University, 31-008 Krakow, Poland
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Reinhard M, Schousboe K, Andersen UB, Buus NH, Rantanen JM, Bech JN, Mafi HM, Langfeldt S, Bharadwaz A, Hørlyck A, Jensen MK, Jeppesen J, Olsen MH, Jacobsen IA, Bibby BM, Christensen KL. Renal Artery Stenting in Consecutive High-Risk Patients With Atherosclerotic Renovascular Disease: A Prospective 2-Center Cohort Study. J Am Heart Assoc 2022; 11:e024421. [PMID: 35322677 PMCID: PMC9075498 DOI: 10.1161/jaha.121.024421] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Mark Reinhard
- Department of Renal Medicine and The Clinic of Hypertension Aarhus University Hospital Denmark.,Department of Clinical Medicine Aarhus University Denmark
| | - Karoline Schousboe
- Department of Endocrinology/Steno Diabetes Center Odense and The Clinic of Hypertension Odense University Hospital Denmark
| | - Ulrik B Andersen
- Department of Clinical Physiology and Nuclear Medicine Rigshospitalet, GlostrupUniversity of Copenhagen Glostrup Denmark
| | - Niels Henrik Buus
- Department of Renal Medicine and The Clinic of Hypertension Aarhus University Hospital Denmark.,Department of Clinical Medicine Aarhus University Denmark
| | | | - Jesper Nørgaard Bech
- Department of Medicine University Clinic in Nephrology and HypertensionGodstrup Regional Hospital Denmark
| | | | - Sten Langfeldt
- Department of Radiology Aarhus University Hospital Aarhus N Denmark
| | | | - Arne Hørlyck
- Department of Radiology Aarhus University Hospital Aarhus N Denmark
| | | | - Jørgen Jeppesen
- Department of Medicine Amager Hvidovre Hospital GlostrupUniversity of Copenhagen Glostrup Denmark.,Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine Holbaek Hospital Denmark.,Centre for Individualized Medicine in Arterial Diseases (CIMA) Department of Regional Health Research University of Southern Denmark Odense C Denmark
| | - Ib Abildgaard Jacobsen
- Department of Endocrinology/Steno Diabetes Center Odense and The Clinic of Hypertension Odense University Hospital Denmark
| | | | - Kent Lodberg Christensen
- Department of Clinical Medicine Aarhus University Denmark.,Department of Cardiology and The Clinic of Hypertension Aarhus University Hospital Denmark
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7
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Iwashima Y, Kusunoki H, Taniyama A, Horio T, Hayashi SI, Kishida M, Fukuda T, Yoshihara F, Ishimitsu T, Kawano Y. Impact of Percutaneous Transluminal Renal Angioplasty on Autonomic Nervous System and Natriuresis in Hypertensive Patients With Renal Artery Stenosis. J Am Heart Assoc 2022; 11:e023655. [PMID: 35261276 PMCID: PMC9075284 DOI: 10.1161/jaha.121.023655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background We investigated the early postoperative effect of percutaneous transluminal renal angioplasty on ambulatory blood pressure (BP) and the circadian characteristics of natriuresis and autonomic nerve activity. Methods and Results A total of 64 patients with hypertension with hemodynamically significant renal artery stenosis (mean age, 60.0±21.0 years; 31.3% fibromuscular dysplasia) who underwent angioplasty were included, and circadian characteristics of natriuresis as well as heart rate variability indices, including 24‐hour BP, low‐frequency and high‐frequency (HF) components, and the percentage of differences between adjacent normal R‐R intervals >50 ms were evaluated using an oscillometric device, TM‐2425, both at baseline and 3 days after angioplasty. In both the fibromuscular dysplasia and atherosclerotic stenosis groups, 24‐hour systolic BP (fibromuscular dysplasia, −19±14; atherosclerotic renal artery stenosis, −11±9 mm Hg), percentage of differences between adjacent normal R‐R intervals >50 ms, HF, brain natriuretic peptide, and nighttime urinary sodium excretion decreased (all P<0.01), and heart rate increased (both P<0.05) after angioplasty. In both groups, revascularization increased the night/day ratios of percentage of differences between adjacent normal R‐R intervals >50 ms (both P<0.01) and HF, and decreased those of low frequency/HF (all P<0.05) and nighttime urinary sodium excretion (fibromuscular dysplasia, 1.17±0.15 to 0.78±0.09; atherosclerotic renal artery stenosis, 1.37±0.10 to 0.99±0.06, both P<0.01). Multiple logistic regression analysis indicated that a 1‐SD increase in baseline low frequency/HF was associated with at least a 15% decrease in 24‐hour systolic BP after angioplasty (odds ratio, 2.30 [95% CI, 1.03–5.67]; P<0.05). Conclusions Successful revascularization results in a significant BP decrease in the early postoperative period. Intrarenal perfusion might be a key modulator of the circadian patterns of autonomic nerve activity and natriuresis, and pretreatment heart rate variability evaluation seems to be important for treatment success.
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Affiliation(s)
- Yoshio Iwashima
- Department of Nephrology and Hypertension Dokkyo Medical University Tochigi Japan.,Division of Hypertension and Nephrology National Cerebral and Cardiovascular Center Osaka Japan
| | - Hiroshi Kusunoki
- Division of Hypertension and Nephrology National Cerebral and Cardiovascular Center Osaka Japan
| | - Akira Taniyama
- Division of Hypertension and Nephrology National Cerebral and Cardiovascular Center Osaka Japan
| | - Takeshi Horio
- Department of Cardiovascular Medicine Ishikiriseiki Hospital Osaka Japan
| | - Shin-Ichiro Hayashi
- Division of Hypertension and Nephrology National Cerebral and Cardiovascular Center Osaka Japan
| | - Masatsugu Kishida
- Division of Hypertension and Nephrology National Cerebral and Cardiovascular Center Osaka Japan
| | - Tetsuya Fukuda
- Department of Radiology National Cerebral and Cardiovascular Center Osaka Japan
| | - Fumiki Yoshihara
- Division of Hypertension and Nephrology National Cerebral and Cardiovascular Center Osaka Japan
| | - Toshihiko Ishimitsu
- Department of Nephrology and Hypertension Dokkyo Medical University Tochigi Japan
| | - Yuhei Kawano
- Division of Hypertension and Nephrology National Cerebral and Cardiovascular Center Osaka Japan.,Department of Medical Technology Teikyo University Fukuoka Tokyo Japan
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8
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Hicks CW, Clark TW, Cooper CJ, de Bhailís ÁM, De Carlo M, Green D, Małyszko J, Miglinas M, Textor SC, Herzog CA, Johansen KL, Reinecke H, Kalra PA. Atherosclerotic Renovascular Disease: A KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference. Am J Kidney Dis 2022; 79:289-301. [PMID: 34384806 PMCID: PMC9834909 DOI: 10.1053/j.ajkd.2021.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
The diagnosis and management of atherosclerotic renovascular disease (ARVD) is complex and controversial. Despite evidence from the ASTRAL (2009) and CORAL (2013) randomized controlled trials showing that percutaneous renal artery revascularization did not improve major outcomes compared with best medical therapy alone over 3-5 years, several areas of uncertainty remain. Medical therapy, including statin and antihypertensive medications, has evolved in recent years, and the use of renin-angiotensin-aldosterone system blockers is now considered the primary means to treat hypertension in the setting of ARVD. However, the criteria to identify kidneys with renal artery stenosis that have potentially salvageable function are evolving. There are also data suggesting that certain high-risk populations with specific clinical manifestations may benefit from revascularization. Here, we provide an overview of the epidemiology, diagnosis, and treatment of ARVD based on consensus recommendations from a panel of physician experts who attended the recent KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference on central and peripheral arterial diseases in chronic kidney disease. Most focus is provided for contentious issues, and we also outline aspects of investigation and management of ARVD that require further research.
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9
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Li Z, He W. A Continuous Blood Pressure Estimation Method Using Photoplethysmography by GRNN-Based Model. SENSORS (BASEL, SWITZERLAND) 2021; 21:7207. [PMID: 34770514 PMCID: PMC8587576 DOI: 10.3390/s21217207] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/13/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
Compared with diastolic blood pressure (DBP) and systolic blood pressure (SBP), the blood pressure (BP) waveform contains richer physiological information that can be used for disease diagnosis. However, most models based on photoplethysmogram (PPG) signals can only estimate SBP and DBP and are susceptible to noise signals. We focus on estimating the BP waveform rather than discrete BP values. We propose a model based on a generalized regression neural network to estimate the BP waveform, SBP and DBP. This model takes the raw PPG signal as input and BP waveform as output. The SBP and DBP are extracted from the estimated BP waveform. In addition, the model contains encoders and decoders, and their role is to be responsible for the conversion between the time domain and frequency domain of the waveform. The prediction results of our model show that the mean absolute error is 3.96 ± 5.36 mmHg for SBP and 2.39 ± 3.28 mmHg for DBP, the root mean square error is 5.54 for SBP and 3.45 for DBP. These results fulfill the Association for the Advancement of Medical Instrumentation (AAMI) standard and obtain grade A according to the British Hypertension Society (BHS) standard. The results show that the proposed model can effectively estimate the BP waveform only using the raw PPG signal.
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Affiliation(s)
| | - Wei He
- State Key Laboratory of Power Transmission Equipment and System Security and New Technology, Chongqing University, Chongqing 400044, China;
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10
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Textor SC. Mortality After Renal Artery Revascularization. Am J Hypertens 2021; 34:795-798. [PMID: 33609351 DOI: 10.1093/ajh/hpab039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Stephen C Textor
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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11
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Li L, Wang M, Li J, Guan X, Xin P, Wang X, Liu Y, Li H, Jiang W, Gong M, Zhang H. Short Term Prognosis of Renal Artery Stenosis Secondary to Acute Type B Aortic Dissection With TEVAR. Front Cardiovasc Med 2021; 8:658952. [PMID: 33969023 PMCID: PMC8102698 DOI: 10.3389/fcvm.2021.658952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/29/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: To determine the effect of renal artery stenosis (RAS) resulting from acute type B aortic dissection (ATBAD) with thoracic endovascular aortic repair (TEVAR) on early prognosis in patients with ATBAD. Methods: A total of 129 ATBAD patients in the National Acute Aortic Syndrome Database (AASCN) who underwent TEVAR between 2019 and 2020 were enrolled in our study. Patients were divided into two groups: the RAS group and the non-RAS group. Results: There were 21 RAS patients (16.3%) and 108 non-RAS patients (83.7%) in our cohort. No patient in our cohort died during the 1-month follow-up. There was no significant difference in preoperative creatinine clearance rate (CCr) between the two groups (90.6 ± 46.1 μmol/L in the RAS group vs. 78.7 ± 39.2 μmol/L in the non-RAS group, P = 0.303) but the RAS group had a significantly lower estimated glomerular filtration rate (eGFR) than the non-RAS group (83.3 ± 25.0 vs. 101.9 ± 26.9 ml/min, respectively; P = 0.028).One month after TEVAR, CCr was significantly higher (99.0 ± 68.1 vs. 78.5 ± 25.8 ml/min, P = 0.043) and eGFR (81.7 ± 23.8 vs. 96.0 ± 20.0 ml/min, P = 0.017) was significantly lower in the RAS group than in the non-RAS group. Conclusions: In ATBAD, RAS could result in acute kidney injury (AKI) in the early stage after TEVAR. The RAS group had a high incidence of hypertension. These results suggest that patients with RAS may need further treatment.
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Affiliation(s)
- Lei Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Maozhou Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Jinzhang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Xinliang Guan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Pu Xin
- Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.,Department of Medical Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Yuyong Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Haiyang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Wenjian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Ming Gong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing, China.,Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
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Abstract
Several important findings bearing on the prevention, detection, and management of hypertension have been reported since publication of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. This review summarizes and places in context the results of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics covered include blood pressure measurement, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and blood pressure threshold for drug therapy, lifestyle and pharmacological management, treatment target blood pressure goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches. Presenting new information in each of these areas has the potential to increase hypertension awareness, treatment, and control which remain essential for the prevention of cardiovascular disease and mortality in the future.
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Affiliation(s)
- Robert M Carey
- Department of Medicine, University of Virginia Health System, Charlottesville (R.M.C)
| | - Jackson T Wright
- Department of Medicine, Case-Western Reserve University School of Medicine, Cleveland, OH (J.T.W.)
| | - Sandra J Taler
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (S.J.T.)
| | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University, New Orleans, LA (P.K.W.)
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13
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Ai H, Zhang HP, Yang GJ, Zheng NX, Tang GD, Li H, Zhou Q, Ren JH, Zhao Y, Sun FC. <p>Severely Impaired Renal Function in Unilateral Atherosclerotic Renal Artery Stenosis Indicated by Renal Slow Perfusion</p>. Int J Gen Med 2020; 13:839-845. [PMID: 33116776 PMCID: PMC7569045 DOI: 10.2147/ijgm.s279457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hu Ai
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Hui-Ping Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Guo-Jian Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Nai-Xin Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Guo-Dong Tang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Qi Zhou
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Jun-Hong Ren
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Ying Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
- Correspondence: Ying Zhao; Fu-Cheng Sun Department of Cardiology, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing100730, ChinaTel +86 15901059087; Tel +86 15901059087 Email ;
| | - Fu-Cheng Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
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14
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The Value of Contrast-Enhanced Ultrasound versus Doppler Ultrasound in Grading Renal Artery Stenosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7145728. [PMID: 32964041 PMCID: PMC7495158 DOI: 10.1155/2020/7145728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023]
Abstract
Objective This study is aimed at exploring the accuracy of contrast-enhanced ultrasound (CEUS) in grading renal artery stenosis. Methods 122 renal arteries with suspected renal artery stenosis were selected. DSA, DUS, and CEUS were performed for all patients with suspected renal artery stenosis in the research. DSA was selected as the gold standard. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of CEUS or Doppler ultrasound (DUS) in the diagnosis of renal artery stenosis were analyzed. The consistency between CEUS and digital subtraction angiography (DSA) was compared. The accuracy of DUS or CEUS in grading renal artery stenosis was assessed by the area under the receiver operating characteristic (ROC) curves and compared between groups. Results The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CEUS in the diagnosis of renal artery stenosis were 88.9%, 87.8%, 88.5%, 93.5%, and 80.0%, respectively. There was no significant difference in grading renal artery stenosis between CEUS and DSA (X2 = 0.643, P = 0.424). 77 of the 122 renal arteries were diagnosed with the stenosis rate more than 30% by CEUS. Compared with the results of DSA, the kappa value of CEUS was 0.749 (P < 0.05). Conclusion CEUS is accurate in grading renal artery stenosis, and it may represent the method of choice in diagnosing renal artery stenosis.
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16
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How should we define appropriate patients for percutaneous transluminal renal angioplasty treatment? Hypertens Res 2020; 43:1015-1027. [PMID: 32572170 DOI: 10.1038/s41440-020-0496-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 01/15/2023]
Abstract
Renovascular hypertension (RVH) is one of the most common causes of secondary hypertension and can result in resistant hypertension. RVH is associated with an increased risk for progressive decline in renal function, cardiac destabilization syndromes including "flash" pulmonary edema, recurrent congestive heart failure, and cerebrocardiovascular disease. The most common cause of renal artery stenosis (RAS) is atherosclerotic lesions, followed by fibromuscular dysplasia. The endovascular technique of percutaneous transluminal renal angioplasty (PTRA) with or without stenting is one of the standard treatments for RAS. Randomized controlled trials comparing medical therapy with PTRA to medical therapy alone have failed to show a benefit of PTRA; however, the subjects of these randomized clinical trials were limited to atherosclerotic RAS patients, and patients with the most severe RAS, who would be more likely to benefit from PTRA, might not have been enrolled in these trials. This review compares international guidelines related to PTRA, reevaluates the effects of PTRA treatment on blood pressure and renal and cardiac function, discusses strategies for the management of RVH patients, and identifies factors that may predict which patients are most likely to benefit from PTRA.
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17
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Zachrisson K, Krupic F, Svensson M, Wigelius A, Jonsson A, Dimopoulou A, Stenborg A, Jensen G, Herlitz H, Gottsäter A, Falkenberg M. Results of renal artery revascularization in the post-ASTRAL era with 4 years mean follow-up. Blood Press 2020; 29:285-290. [PMID: 32363961 DOI: 10.1080/08037051.2020.1756740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To investigate contemporary results of percutaneous transluminal renal angioplasty (PTRA).Materials and Methods: A multicentre retrospective study analysing all patients treated with PTRA for primary symptomatic renal artery stenosis (RAS) between 2010 and 2013 at four tertiary centres. Procedures during the preceding four years were counted to evaluate for change in PTRA frequency.Results: The number of PTRA procedures decreased by approximately 50% from 2006 to 2013. Patients treated in the post-ASTRAL period (n = 224) had a significant reduction in mean systolic pressure (168 to 146 mmHg, p < 0.01), diastolic pressure (84 to 76 mmHg, p < 0.01), number of anti-hypertensive drugs (3.54 to 3.05, p < 0.01), and anti-hypertensive treatment index (21.75 to 16.92, p < 0.01) compared to before PTRA. These improvements were maintained at one year and at the last clinical evaluation after a mean follow-up of 4.31 years. Renal function increased transiently without sustained improvement, or deterioration, during later follow-up. Thirteen patients (5.8%) eventually required dialysis, nine of these had eGFR <20 ml/min/1.73 m2 before PTRA. There was no difference in outcomes between subgroups differentiated by different indications for PTRA.Conclusion: The frequency of PTRA has decreased, indicating a higher threshold for invasive treatment of RAS in recent years. The reduction in blood pressures, the reduced need for anti-hypertensive medication, and stabilization of renal function over time suggest a clinical benefit for most patients who are now being treated with PTRA.
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Affiliation(s)
- Karin Zachrisson
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ferid Krupic
- Department of Orthopedics and Anesthesiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Svensson
- Health Metrics Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Wigelius
- Diagnostic Radiology, Department of Radiation Sciences, Umeå University Hospital, Umeå, Sweden
| | - Andreas Jonsson
- Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden
| | | | - Anna Stenborg
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Gert Jensen
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Herlitz
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Gottsäter
- Vascular Center, Clinical Vascular Disease Research, Skåne University Hospital, Malmö, Sweden
| | - Mårten Falkenberg
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Percutaneous transluminal renal angioplasty of global kidney ischemia improves renal function and blood pressure. IJC HEART & VASCULATURE 2020; 27:100475. [PMID: 32309529 PMCID: PMC7154316 DOI: 10.1016/j.ijcha.2020.100475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022]
Abstract
Background Renal artery stenosis (RAS) can lead to hypertension and renal failure. Nevertheless, its treatment by percutaneous transluminal renal angioplasty (PTRA) remains controversial. It is unknown, whether patients with global kidney ischemia (GKI), that means patients with bilateral RAS or RAS with a single functioning kidney, may benefit from PTRA or not. Methods We retrospectively analyzed 93 patients with RAS (25 bilateral or single functioning kidney) undergoing PTRA. Patients had refractory hypertension (≥3 medications). Blood pressure, antihypertensive drugs and serum-creatinine were compared pre-/post-intervention and at 1 year’s follow-up. Results At 1 year after PTRA of patients with GKI, systolic and diastolic blood pressure were significantly reduced compared to patients with unilateral PTRA (systolic: −19.1 ± 10.5 [bilateral] vs. −11.4 ± 12.1 mmHg [unilateral], P < 0.01; diastolic: −10.1 ± 6.8 mmHg vs. −6.3 ± 6.6 mmHg, P < 0.05). The number of antihypertensive drugs was reduced by −0.8 ± 3.0 at 1 year in patients with GKI, while it increased by +0.1 ± 3.5 in the unilateral RAS group (P < 0.001). Furthermore, post-interventional serum-creatinine decreased by −34.6 ± 31.4 μmol/I after of patients with GKI (P < 0.001 vs. baseline). In patients with unilateral PTRA, a non-significant increase in serum-creatinine was observed (+8.3 ± 2 μmol/l). Conclusion PTRA in patients with GKI led to improved blood pressure and renal function. A large, well-designed, randomized clinical trial targeting this population is still needed. The benefit of PTRA should be measured with the risks in each patient individually.
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Affiliation(s)
- Stephen C Textor
- From the Division of Hypertension and Nephrology, Mayo Clinic, Rochester, MN
| | - Sandra J Taler
- From the Division of Hypertension and Nephrology, Mayo Clinic, Rochester, MN
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