Blood pressure response to renal artery stenting in 901 patients from five prospective multicenter FDA-approved trials.

Abstract

BACKGROUND:

Renal artery stent revascularization is commonly used for renovascular hypertension. Clinical predictors associated with blood pressure (BP) improvement after renal artery stent revascularization are not well understood.

METHODS:

Patient-level data from 901 patients in five prospective multicenter Food and Drug Administration-approved investigational device exemption studies of renal artery stent revascularization was pooled. BP response was defined as reduction of systolic BP (SBP) by >10 mm Hg. Stent patency was defined within each study. Associations of BP reduction were determined by logistic regression.

RESULTS:

Of 901 patients, complete outcome information was available in 527. Of these, 212/527 (40%) were male, mean age was 63 ± 13 years, 196/544 (36%) were diabetic and 504/527 (96%) had a SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg at baseline. Compared to baseline, 9-month systolic (164 ± 21 mm Hg vs. 146 ± 22 mm Hg, P < 0.0001) and diastolic (79 ± 13 mm Hg vs. 76 ± 12 mm Hg, P < 0.0001) BP declined significantly. Nine-month stent patency was 90% (305/339). In a univariate analysis, baseline SBP >150 mm Hg (OR = 4.09, CI = 2.74-6.12, P < 0.0001) was positively associated with BP response following renal artery stent revascularization. In a multivariable analysis, baseline SBP remained associated with a positive BP response (OR = 1.76, CI = 1.53-2.03, P < 0.0001).

CONCLUSIONS:

In the largest pooled dataset of patients treated with renal artery stent revascularization, SBP and DBP were significantly lower at 9-months. Elevated baseline SBP (>150 mm Hg) was strongly associated with BP reduction after the procedure.

• Authors: Ido Weinberg, Michelle J Keyes, Jay Giri, Kevin R Rogers, Jeffrey W Olin, Christopher J White, Michael R Jaff
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 83 Issue 4 Pg. 603-9 (Mar 01 2014) ISSN: 1522-726X [Electronic] United States
• PMID: 24307609 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2013 Wiley Periodicals, Inc.

Topics

• Aged
• Blood Pressure
• Chi-Square Distribution
• Endovascular Procedures (adverse effects, instrumentation)
• Female
• Humans
• Hypertension, Renovascular (diagnosis, etiology, physiopathology, therapy)
• Logistic Models
• Male
• Middle Aged
• Multicenter Studies as Topic
• Multivariate Analysis
• Odds Ratio
• Prospective Studies
• Renal Artery Obstruction (complications, diagnosis, physiopathology, therapy)
• Risk Factors
• Stents
• Time Factors
• Treatment Outcome
• United States
• United States Food and Drug Administration