BLOOD PRESSURE AND RENAL FUNCTION CHANGES AFTER REVASCULARIZATION OF RENAL ARTERY STENOSIS IN 3 DIFFERENT COHORTS OF PATIENTS

Abstract

Objective: To analyze the effects at 12 months on blood pressure (BP) and renal function in patients with renal artery stenosis (RAS) undergoing percutaneous transluminal angioplasty (PTA), recruited from 3 different sources (Vascular Surgery Department, Hypertension Unit and Renal Transplantation Department). Design and method: Observational, retrospective study of patients undergoing PTA because of RAS mostly detected when screening patients with peripheral artery disease (G.1, n=20), when studying patients with resistant hypertension or with clinical suspicion of RAS (G.2, n=28) or in kidney transplant patients (G.3, n=21) with renal function impairment and/or elevation of BP. RAS is defined as a reduction of >70% of the renal artery lumen. Results: Sixty-nine patients were analyzed (mean age: 67±12yr, 64% male). Overall, mean±S.D. SBP/DBP (mmHg) was 147.4±20.6 and 75.7±11.8, and the estimated glomerular filtration rate (eGFR) was 48.7±27.0 mL/min/1.73m2. At baseline, G.1 had a higher prevalence of smoking patients (90%) and patients with a history of major vascular events (100%), lower DBP (70.0±9.8 mmHg) and better renal function (eGFR: 62.5±23.2 mL/min/1.73m2), compared to G.2 and G.3. 12-months after PTA, patients in G.2 and G.3 (but not those in G.1) showed a decrease in BP: variation (δ) SBP(mmHg): mean (95%CI)= -18.9 (-26.7 to -11.0) and -20.0 (-29.8 to -10.1), respectively; p<0.001 for both; δDBP (mmHg): mean (95%CI)= -6.6(-10.7 to -2.4),p=0.003 and -6.3 (-11.7 to -0.8), p=0.027. Regarding renal function, it only improved in G.3 group: δeGFR (mL/min/1.73m2): mean (95%CI)= 8.9(1.5 to 16.4),p=0.022, and showed a trend to become worst in G.1 group: -6.5(-13.4 to 0.3),p=0.061. After adjusting for confounding variables, δSBP was associated with baseline SBP (r= -0.709,p<0.001) and the origin group (Rho = -0.362,p = 0.003); δeGFR was associated with baseline eGFR (r= -0.508,p<0.001) and the origin group (Rho= 0.356, p= 0.004). Conclusions: BP decreased 12-months after PTA in patients with suspected RAS because of resistant hypertension. BP and renal function improved after PTA in kidney transplant patients with diagnosis of RAS. Higher BP levels and lower eGFR correlated with better results. Patients with peripheral artery disease screened for RAS showed no change in BP or renal function after PTA.