Vol 18, No 1 (2014)
Original paper
Published online: 2014-09-19
Incidence of renal artery stenosis in hypertensive patients with ischemic heart disease that underwent simultaneous coronary and renal artery catheterization
Nadciśnienie tętnicze 2014;18(1):27-36.
Abstract
Backgroud. Renovascular hypertension is one of the most common form of hypertension with potentially reversible cause. The main etiology of this form of hypertension is atherosclerotic renal artery stenosis (RAS). Recent studies suggest that the optimal conservative treatment is the treatment of choice in most of the patient with ARAS. The aim of the study was to evaluate chosen biochemical parameters and blood pressure profile in hypertensive people with new diagnosis of renal artery stenosis.
Material and methods. The study was carried out in the Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, in 162 patients with arterial hypertension. Patients were recruited among those referred to the hospital for elective coronarography with risk factors of renovascular hypertension. In addition to simultaneous coronarary and renal angiography, among other office and 24-hour automated blood pressure measurements (ABPM), plasma renin activity, C-reactive protein, kidney function were determined.
Results. In the study group, the prevalence of RAS and significant RAS ≥ 50% was respectively 28.4% and 11.1%. Unilateral significant stenosis was 8.6%, and was 3.5 times more frequent than bilateral RAS (2.4%). When comparing patients with and without RAS (RAS+ vs. RAS–), group RAS+ was older and had lower glomelular filtration rate. Group RAS+ had also higher blood pressure: office diastolic (95.4 ± 15.3 vs. 89.8 ± 1.,7; p < 0.05) and in ABPM mean 24-hour systolic (132.1 ± 16.8 vs. 125.7 ± 14.1; p < 0.05) mean both systolic and diastolic at night (128.7/72.8 ± 20.5/10.5 vs. 116.4/67.3 ± 15.2/9.6 mm Hg; p < 0.01). Moreover the night systolic blood pressure fall was lower (FALLSBP) (3.6 ± 11.2% vs. 9.9 ± 7.3%; p < 0.01), as well as diastolic (FALLDBP) (5.8 ± 12.3% vs. 11.6 ± 8.9%; p < 0.01). The were no significant differences in biochemical parameters, office and automated (ABPM) blood pressure measurements between patients with low-grade (< 50%) and high-grade (> 50%) RAS.
Conclusions
1. The prevalence of renal artery stenosis (RAS) in hypertensive patients with suspicion of coronary artery disease and additional risk factors of RAS referred for elective coronarography is high and justifies simultaneous angiography of renal arteries.
2. Patients with renal artery stenosis were older, were characterized by significantly lower GFR, higher blood pressure during the night and lower pressure drop in the night when compared to patients without renal artery stenosis.
3. Among patients with renal artery stenosis there were no significant differences in biochemical and hemodynamic parameters in relation relation to severity of renal artery stenosis.
Material and methods. The study was carried out in the Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, in 162 patients with arterial hypertension. Patients were recruited among those referred to the hospital for elective coronarography with risk factors of renovascular hypertension. In addition to simultaneous coronarary and renal angiography, among other office and 24-hour automated blood pressure measurements (ABPM), plasma renin activity, C-reactive protein, kidney function were determined.
Results. In the study group, the prevalence of RAS and significant RAS ≥ 50% was respectively 28.4% and 11.1%. Unilateral significant stenosis was 8.6%, and was 3.5 times more frequent than bilateral RAS (2.4%). When comparing patients with and without RAS (RAS+ vs. RAS–), group RAS+ was older and had lower glomelular filtration rate. Group RAS+ had also higher blood pressure: office diastolic (95.4 ± 15.3 vs. 89.8 ± 1.,7; p < 0.05) and in ABPM mean 24-hour systolic (132.1 ± 16.8 vs. 125.7 ± 14.1; p < 0.05) mean both systolic and diastolic at night (128.7/72.8 ± 20.5/10.5 vs. 116.4/67.3 ± 15.2/9.6 mm Hg; p < 0.01). Moreover the night systolic blood pressure fall was lower (FALLSBP) (3.6 ± 11.2% vs. 9.9 ± 7.3%; p < 0.01), as well as diastolic (FALLDBP) (5.8 ± 12.3% vs. 11.6 ± 8.9%; p < 0.01). The were no significant differences in biochemical parameters, office and automated (ABPM) blood pressure measurements between patients with low-grade (< 50%) and high-grade (> 50%) RAS.
Conclusions
1. The prevalence of renal artery stenosis (RAS) in hypertensive patients with suspicion of coronary artery disease and additional risk factors of RAS referred for elective coronarography is high and justifies simultaneous angiography of renal arteries.
2. Patients with renal artery stenosis were older, were characterized by significantly lower GFR, higher blood pressure during the night and lower pressure drop in the night when compared to patients without renal artery stenosis.
3. Among patients with renal artery stenosis there were no significant differences in biochemical and hemodynamic parameters in relation relation to severity of renal artery stenosis.
Keywords: arterial hypertensionrenal artery stenosisrenovascular hypertensionABPMcoronary artery disease