Incidental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography

Charanjit Rihal, Stephen C Textor, Jerome F. Breen, Michael A. McKusick, Diane E. Grill, John W. Hallett, David Holmes

Research output: Contribution to journalArticle

189 Citations (Scopus)

Abstract

Objective: To determine the feasibility, safety, and clinical yield of angiographic screening among hypertensive patients undergoing coronary angiography. Patients and Methods: This study was a prospective cohort analysis of hypertensive patients who underwent cardiac catheterization at a tertiary care referral center from July 1998 to March 1999. Abdominal aortography was performed to screen for renal artery stenosis, the percentage of which was measured. Results: The mean ± SD age of the 297 study patients was 64.9±10.2 years; 58.6% were male, and 98.0% were white. Mean ± SD systolic/diastolic blood pressure was 142.8±22.5/79.6±11.4 mm Hg. Aortography required a mean incremental dose of 62±9 mL of nonionic contrast agent. No complications were attributable to aortography. Of 680 renal arteries, 611 (90%) were visualized adequately. Also, 53% of patients had normal renal arteries, 28% had stenoses less than 50%, and 19.2% had stenoses of 50% or more. Renal artery stenosis was bilateral in 3.7% of patients and high grade (>70% stenosis) in 7%. Patients with renal artery stenosis were more likely to have had a previous coronary intervention. In multivariate analysis, systolic blood pressure (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.03-1.38; P=.02), history of stroke or transient ischemic attack (OR, 2.7; 95% CI, 1.27-5.78; P=.01), and cancer (OR, 2.0; 95% CI, 1.02-3.82; P=.04) independently correlated with renal artery stenosis of 50% or more. Conclusion: The prevalence of incidental renal artery stenosis among hypertensive patients undergoing coronary catheterization is significant. Therefore, screening abdominal aortography should be considered in these patients to better define their risk of cardiovascular complications.

Original languageEnglish (US)
Pages (from-to)309-316
Number of pages8
JournalMayo Clinic Proceedings
Volume77
Issue number4
StatePublished - 2002

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Renal Artery Obstruction
Coronary Angiography
Aortography
Blood Pressure
Pathologic Constriction
Odds Ratio
Renal Artery
Confidence Intervals
Tertiary Care Centers
Transient Ischemic Attack
Cardiac Catheterization
Catheterization
Contrast Media
Cohort Studies
Multivariate Analysis
Stroke
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Incidental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography. / Rihal, Charanjit; Textor, Stephen C; Breen, Jerome F.; McKusick, Michael A.; Grill, Diane E.; Hallett, John W.; Holmes, David.

In: Mayo Clinic Proceedings, Vol. 77, No. 4, 2002, p. 309-316.

Research output: Contribution to journalArticle

Rihal, Charanjit ; Textor, Stephen C ; Breen, Jerome F. ; McKusick, Michael A. ; Grill, Diane E. ; Hallett, John W. ; Holmes, David. / Incidental renal artery stenosis among a prospective cohort of hypertensive patients undergoing coronary angiography. In: Mayo Clinic Proceedings. 2002 ; Vol. 77, No. 4. pp. 309-316.
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abstract = "Objective: To determine the feasibility, safety, and clinical yield of angiographic screening among hypertensive patients undergoing coronary angiography. Patients and Methods: This study was a prospective cohort analysis of hypertensive patients who underwent cardiac catheterization at a tertiary care referral center from July 1998 to March 1999. Abdominal aortography was performed to screen for renal artery stenosis, the percentage of which was measured. Results: The mean ± SD age of the 297 study patients was 64.9±10.2 years; 58.6{\%} were male, and 98.0{\%} were white. Mean ± SD systolic/diastolic blood pressure was 142.8±22.5/79.6±11.4 mm Hg. Aortography required a mean incremental dose of 62±9 mL of nonionic contrast agent. No complications were attributable to aortography. Of 680 renal arteries, 611 (90{\%}) were visualized adequately. Also, 53{\%} of patients had normal renal arteries, 28{\%} had stenoses less than 50{\%}, and 19.2{\%} had stenoses of 50{\%} or more. Renal artery stenosis was bilateral in 3.7{\%} of patients and high grade (>70{\%} stenosis) in 7{\%}. Patients with renal artery stenosis were more likely to have had a previous coronary intervention. In multivariate analysis, systolic blood pressure (odds ratio [OR], 1.2; 95{\%} confidence interval [CI], 1.03-1.38; P=.02), history of stroke or transient ischemic attack (OR, 2.7; 95{\%} CI, 1.27-5.78; P=.01), and cancer (OR, 2.0; 95{\%} CI, 1.02-3.82; P=.04) independently correlated with renal artery stenosis of 50{\%} or more. Conclusion: The prevalence of incidental renal artery stenosis among hypertensive patients undergoing coronary catheterization is significant. Therefore, screening abdominal aortography should be considered in these patients to better define their risk of cardiovascular complications.",
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AU - Hallett, John W.

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N2 - Objective: To determine the feasibility, safety, and clinical yield of angiographic screening among hypertensive patients undergoing coronary angiography. Patients and Methods: This study was a prospective cohort analysis of hypertensive patients who underwent cardiac catheterization at a tertiary care referral center from July 1998 to March 1999. Abdominal aortography was performed to screen for renal artery stenosis, the percentage of which was measured. Results: The mean ± SD age of the 297 study patients was 64.9±10.2 years; 58.6% were male, and 98.0% were white. Mean ± SD systolic/diastolic blood pressure was 142.8±22.5/79.6±11.4 mm Hg. Aortography required a mean incremental dose of 62±9 mL of nonionic contrast agent. No complications were attributable to aortography. Of 680 renal arteries, 611 (90%) were visualized adequately. Also, 53% of patients had normal renal arteries, 28% had stenoses less than 50%, and 19.2% had stenoses of 50% or more. Renal artery stenosis was bilateral in 3.7% of patients and high grade (>70% stenosis) in 7%. Patients with renal artery stenosis were more likely to have had a previous coronary intervention. In multivariate analysis, systolic blood pressure (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.03-1.38; P=.02), history of stroke or transient ischemic attack (OR, 2.7; 95% CI, 1.27-5.78; P=.01), and cancer (OR, 2.0; 95% CI, 1.02-3.82; P=.04) independently correlated with renal artery stenosis of 50% or more. Conclusion: The prevalence of incidental renal artery stenosis among hypertensive patients undergoing coronary catheterization is significant. Therefore, screening abdominal aortography should be considered in these patients to better define their risk of cardiovascular complications.

AB - Objective: To determine the feasibility, safety, and clinical yield of angiographic screening among hypertensive patients undergoing coronary angiography. Patients and Methods: This study was a prospective cohort analysis of hypertensive patients who underwent cardiac catheterization at a tertiary care referral center from July 1998 to March 1999. Abdominal aortography was performed to screen for renal artery stenosis, the percentage of which was measured. Results: The mean ± SD age of the 297 study patients was 64.9±10.2 years; 58.6% were male, and 98.0% were white. Mean ± SD systolic/diastolic blood pressure was 142.8±22.5/79.6±11.4 mm Hg. Aortography required a mean incremental dose of 62±9 mL of nonionic contrast agent. No complications were attributable to aortography. Of 680 renal arteries, 611 (90%) were visualized adequately. Also, 53% of patients had normal renal arteries, 28% had stenoses less than 50%, and 19.2% had stenoses of 50% or more. Renal artery stenosis was bilateral in 3.7% of patients and high grade (>70% stenosis) in 7%. Patients with renal artery stenosis were more likely to have had a previous coronary intervention. In multivariate analysis, systolic blood pressure (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.03-1.38; P=.02), history of stroke or transient ischemic attack (OR, 2.7; 95% CI, 1.27-5.78; P=.01), and cancer (OR, 2.0; 95% CI, 1.02-3.82; P=.04) independently correlated with renal artery stenosis of 50% or more. Conclusion: The prevalence of incidental renal artery stenosis among hypertensive patients undergoing coronary catheterization is significant. Therefore, screening abdominal aortography should be considered in these patients to better define their risk of cardiovascular complications.

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