Predicting blood pressure response after renal artery stenting

Adam W. Beck, Brian W. Nolan, Randall R De Martino, Theodore H. Yuo, William J. Tanski, Daniel B. Walsh, Richard P. Powell, Jack L. Cronenwett

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Although technical success of renal artery stenting (RAS) is high and adverse events are infrequent, clinical success (improved blood pressure and renal function) and durability have been less predictable. Identifying those patients who will respond to RAS could improve overall outcomes of the procedure. Methods: This was a retrospective analysis of all patients who underwent RAS for treatment of renovascular hypertension (RVH) between 2001 and 2007 at Dartmouth-Hitchcock Medical Center. The primary outcome measure was blood pressure improvement or cure as judged by American Heart Association criteria. Estimated glomerular filtration rate (eGFR), number of antihypertensive medications, and survival were evaluated as secondary outcomes. Univariate and multivariate analyses were performed to identify factors associated with blood pressure improvement at the last follow-up. Results: During the 6-year period, 129 patients (179 renal arteries) underwent stent placement for RVH. Procedural complications occurred nine patients (7.0%). Average length follow-up was 1.5 years. Follow-up data were obtained in 122 patients (95%). At last follow-up, there were significant improvements in systolic blood pressure (161 vs 144 mm Hg, P < .001), diastolic blood pressure (80 vs 73 mm Hg, P < .001), and number of antihypertensive medications (3.1 vs 2.8, P = .034). The eGFR was improved in 16% of patients, stable in 60%, and worse in 24%. By multivariate analysis, a baseline eGFR <40 mL/min/1.73 m 2 (odds ratio, 1.6; 95% confidence interval [CI], 1.0-2.9; P = .02) and female gender (OR, 1.3; 95% CI, 1.0-2.1; P = .04) were independent predictors of failure to achieve blood pressure improvement. By 2 and 4 years of follow-up, sustained blood pressure improvement was present in 67% of patients with a baseline eGFR of ≥40 mL/min/1.73 m 2 and in 31% of patients with a baseline eGFR <40 mL/min/1.73 m 2. During 2 years of follow-up, survival was similar between patients with sustained blood pressure response and those without. Conclusion: Patients treated for RVH who have a baseline eGFR of ≥40 mL/min/1.73 m 2 demonstrate a better response to RAS at each follow-up interval, with a significant difference at 2 to 4 years, compared with patients with an eGFR <40 mL/min/1.73 m 2.

Original languageEnglish (US)
Pages (from-to)380-385
Number of pages6
JournalJournal of Vascular Surgery
Volume51
Issue number2
DOIs
StatePublished - Feb 2010
Externally publishedYes

Fingerprint

Renal Artery
Blood Pressure
Glomerular Filtration Rate
Renovascular Hypertension
Antihypertensive Agents
Multivariate Analysis
Confidence Intervals
Survival
Stents
Odds Ratio
Outcome Assessment (Health Care)
Kidney

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Beck, A. W., Nolan, B. W., De Martino, R. R., Yuo, T. H., Tanski, W. J., Walsh, D. B., ... Cronenwett, J. L. (2010). Predicting blood pressure response after renal artery stenting. Journal of Vascular Surgery, 51(2), 380-385. https://doi.org/10.1016/j.jvs.2009.08.088

Predicting blood pressure response after renal artery stenting. / Beck, Adam W.; Nolan, Brian W.; De Martino, Randall R; Yuo, Theodore H.; Tanski, William J.; Walsh, Daniel B.; Powell, Richard P.; Cronenwett, Jack L.

In: Journal of Vascular Surgery, Vol. 51, No. 2, 02.2010, p. 380-385.

Research output: Contribution to journalArticle

Beck, AW, Nolan, BW, De Martino, RR, Yuo, TH, Tanski, WJ, Walsh, DB, Powell, RP & Cronenwett, JL 2010, 'Predicting blood pressure response after renal artery stenting', Journal of Vascular Surgery, vol. 51, no. 2, pp. 380-385. https://doi.org/10.1016/j.jvs.2009.08.088
Beck, Adam W. ; Nolan, Brian W. ; De Martino, Randall R ; Yuo, Theodore H. ; Tanski, William J. ; Walsh, Daniel B. ; Powell, Richard P. ; Cronenwett, Jack L. / Predicting blood pressure response after renal artery stenting. In: Journal of Vascular Surgery. 2010 ; Vol. 51, No. 2. pp. 380-385.
@article{6882e8f14e344af7baf77b64c68208b7,
title = "Predicting blood pressure response after renal artery stenting",
abstract = "Background: Although technical success of renal artery stenting (RAS) is high and adverse events are infrequent, clinical success (improved blood pressure and renal function) and durability have been less predictable. Identifying those patients who will respond to RAS could improve overall outcomes of the procedure. Methods: This was a retrospective analysis of all patients who underwent RAS for treatment of renovascular hypertension (RVH) between 2001 and 2007 at Dartmouth-Hitchcock Medical Center. The primary outcome measure was blood pressure improvement or cure as judged by American Heart Association criteria. Estimated glomerular filtration rate (eGFR), number of antihypertensive medications, and survival were evaluated as secondary outcomes. Univariate and multivariate analyses were performed to identify factors associated with blood pressure improvement at the last follow-up. Results: During the 6-year period, 129 patients (179 renal arteries) underwent stent placement for RVH. Procedural complications occurred nine patients (7.0{\%}). Average length follow-up was 1.5 years. Follow-up data were obtained in 122 patients (95{\%}). At last follow-up, there were significant improvements in systolic blood pressure (161 vs 144 mm Hg, P < .001), diastolic blood pressure (80 vs 73 mm Hg, P < .001), and number of antihypertensive medications (3.1 vs 2.8, P = .034). The eGFR was improved in 16{\%} of patients, stable in 60{\%}, and worse in 24{\%}. By multivariate analysis, a baseline eGFR <40 mL/min/1.73 m 2 (odds ratio, 1.6; 95{\%} confidence interval [CI], 1.0-2.9; P = .02) and female gender (OR, 1.3; 95{\%} CI, 1.0-2.1; P = .04) were independent predictors of failure to achieve blood pressure improvement. By 2 and 4 years of follow-up, sustained blood pressure improvement was present in 67{\%} of patients with a baseline eGFR of ≥40 mL/min/1.73 m 2 and in 31{\%} of patients with a baseline eGFR <40 mL/min/1.73 m 2. During 2 years of follow-up, survival was similar between patients with sustained blood pressure response and those without. Conclusion: Patients treated for RVH who have a baseline eGFR of ≥40 mL/min/1.73 m 2 demonstrate a better response to RAS at each follow-up interval, with a significant difference at 2 to 4 years, compared with patients with an eGFR <40 mL/min/1.73 m 2.",
author = "Beck, {Adam W.} and Nolan, {Brian W.} and {De Martino}, {Randall R} and Yuo, {Theodore H.} and Tanski, {William J.} and Walsh, {Daniel B.} and Powell, {Richard P.} and Cronenwett, {Jack L.}",
year = "2010",
month = "2",
doi = "10.1016/j.jvs.2009.08.088",
language = "English (US)",
volume = "51",
pages = "380--385",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Predicting blood pressure response after renal artery stenting

AU - Beck, Adam W.

AU - Nolan, Brian W.

AU - De Martino, Randall R

AU - Yuo, Theodore H.

AU - Tanski, William J.

AU - Walsh, Daniel B.

AU - Powell, Richard P.

AU - Cronenwett, Jack L.

PY - 2010/2

Y1 - 2010/2

N2 - Background: Although technical success of renal artery stenting (RAS) is high and adverse events are infrequent, clinical success (improved blood pressure and renal function) and durability have been less predictable. Identifying those patients who will respond to RAS could improve overall outcomes of the procedure. Methods: This was a retrospective analysis of all patients who underwent RAS for treatment of renovascular hypertension (RVH) between 2001 and 2007 at Dartmouth-Hitchcock Medical Center. The primary outcome measure was blood pressure improvement or cure as judged by American Heart Association criteria. Estimated glomerular filtration rate (eGFR), number of antihypertensive medications, and survival were evaluated as secondary outcomes. Univariate and multivariate analyses were performed to identify factors associated with blood pressure improvement at the last follow-up. Results: During the 6-year period, 129 patients (179 renal arteries) underwent stent placement for RVH. Procedural complications occurred nine patients (7.0%). Average length follow-up was 1.5 years. Follow-up data were obtained in 122 patients (95%). At last follow-up, there were significant improvements in systolic blood pressure (161 vs 144 mm Hg, P < .001), diastolic blood pressure (80 vs 73 mm Hg, P < .001), and number of antihypertensive medications (3.1 vs 2.8, P = .034). The eGFR was improved in 16% of patients, stable in 60%, and worse in 24%. By multivariate analysis, a baseline eGFR <40 mL/min/1.73 m 2 (odds ratio, 1.6; 95% confidence interval [CI], 1.0-2.9; P = .02) and female gender (OR, 1.3; 95% CI, 1.0-2.1; P = .04) were independent predictors of failure to achieve blood pressure improvement. By 2 and 4 years of follow-up, sustained blood pressure improvement was present in 67% of patients with a baseline eGFR of ≥40 mL/min/1.73 m 2 and in 31% of patients with a baseline eGFR <40 mL/min/1.73 m 2. During 2 years of follow-up, survival was similar between patients with sustained blood pressure response and those without. Conclusion: Patients treated for RVH who have a baseline eGFR of ≥40 mL/min/1.73 m 2 demonstrate a better response to RAS at each follow-up interval, with a significant difference at 2 to 4 years, compared with patients with an eGFR <40 mL/min/1.73 m 2.

AB - Background: Although technical success of renal artery stenting (RAS) is high and adverse events are infrequent, clinical success (improved blood pressure and renal function) and durability have been less predictable. Identifying those patients who will respond to RAS could improve overall outcomes of the procedure. Methods: This was a retrospective analysis of all patients who underwent RAS for treatment of renovascular hypertension (RVH) between 2001 and 2007 at Dartmouth-Hitchcock Medical Center. The primary outcome measure was blood pressure improvement or cure as judged by American Heart Association criteria. Estimated glomerular filtration rate (eGFR), number of antihypertensive medications, and survival were evaluated as secondary outcomes. Univariate and multivariate analyses were performed to identify factors associated with blood pressure improvement at the last follow-up. Results: During the 6-year period, 129 patients (179 renal arteries) underwent stent placement for RVH. Procedural complications occurred nine patients (7.0%). Average length follow-up was 1.5 years. Follow-up data were obtained in 122 patients (95%). At last follow-up, there were significant improvements in systolic blood pressure (161 vs 144 mm Hg, P < .001), diastolic blood pressure (80 vs 73 mm Hg, P < .001), and number of antihypertensive medications (3.1 vs 2.8, P = .034). The eGFR was improved in 16% of patients, stable in 60%, and worse in 24%. By multivariate analysis, a baseline eGFR <40 mL/min/1.73 m 2 (odds ratio, 1.6; 95% confidence interval [CI], 1.0-2.9; P = .02) and female gender (OR, 1.3; 95% CI, 1.0-2.1; P = .04) were independent predictors of failure to achieve blood pressure improvement. By 2 and 4 years of follow-up, sustained blood pressure improvement was present in 67% of patients with a baseline eGFR of ≥40 mL/min/1.73 m 2 and in 31% of patients with a baseline eGFR <40 mL/min/1.73 m 2. During 2 years of follow-up, survival was similar between patients with sustained blood pressure response and those without. Conclusion: Patients treated for RVH who have a baseline eGFR of ≥40 mL/min/1.73 m 2 demonstrate a better response to RAS at each follow-up interval, with a significant difference at 2 to 4 years, compared with patients with an eGFR <40 mL/min/1.73 m 2.

UR - http://www.scopus.com/inward/record.url?scp=75149165097&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=75149165097&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2009.08.088

DO - 10.1016/j.jvs.2009.08.088

M3 - Article

VL - 51

SP - 380

EP - 385

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 2

ER -